霍姆溶液对老年前列腺电切术中血浆胶体渗透压和电解质的影响

Effects of hypertonic sodium chloride hydroxyethyl starch 40 on maintaining the homeostasis of plasma colloid osmotic pressure and blood electrolyte during transurethral resection of prostates in the elderly

目的观察霍姆溶液(高渗羟乙基淀粉40溶液)对前列腺电切术(transurethral resection of prostates,TURP)中老年患者血浆胶体渗透压(colloid osmotic pressure,COP)和血电解质(Na^+、K^+)的影响。方法择期在硬膜外麻醉下行TURP术的老年男性患者45例,ASA分级Ⅰ-Ⅱ级,随机分为高渗组(H组,n=15),羟乙基淀粉溶液组(HS组,n=15),林格氏液组(R组,n=15)。于硬膜外麻醉开始用药同时分别给予高渗液、羟乙基淀粉溶液、林格氏液,按4 ml/min输注1 h,记录术前(T1)、输注完毕即刻(T2)、术毕即刻(T3)血浆胶体渗透压,血Na^+、K^+值及各项血流动力学指标(Map、HR、SpO_2,CVP)。结果 H组与HS组间血浆COP的变化无显著性差异,与R组相比,血浆COP变化较小,差异有统计学意义(P<0.01)。三组血K^+值变化均无明显差异,H组与HS组、R组相比,血Na^+变化差异均具有统计学意义(P<0.01);H组、HS组的各项血流动力学指标较R组平稳。结论老年前列腺电切术患者术中应用高渗羟乙基淀粉40溶液有利于维持血浆COP和机体内环境稳定,减少前列腺电切综合征(transurethralresection of prostate syndrome,TURS)的发生。

Objective To study the effects of injection of hypertonic sodium chloride hydroxyethyl starch 40 on plasma colloid osmotic pressure and electrolyte（K＋,Na＋） during transurethral resection of prostates in the elderly. Methods Forty-five elderly patients undergoing elective TURP with epidural anesthesia were divided randomly into three groups： Holm group（H）,Hes groups（HS） and lactic Ring＇s solution group（R）. At the beginning of anesthesia, solutions of Holm,Hes or lactic Ring＇s were given with continuous infusion rate of 4 ml/min for one hour respectively. The blood samples were taken to measure the levels of electrolytes K＋ and Na＋ plasma colloid osmotic pressure and hemodynamic parameters （Map,HR, Sp02,CVP） before anesthesia, at 1 h after operation and at the completion of operation. Results The plasma colloid osmotic pressure was maintained to be constant in groups treated by either H or HS,whereas the injection of R solution failed to provide this effect. The levels of sodium in the blood in H group were more constant than that in HS group and in R group. Furthermore,H and HS group treatment provided more stable hemodynamics parameters. Conclusion The hypertonic sodium chloride hydroxyethyl starch 40 injection during transurethral resection of prostates can provide a more steady homeostatic internal environment in old patients which may help to reduce the incidence of transurethral resection of prostate syndrome（TURS）.