高渗氯化钠羟乙基淀粉40对行经尿道前列腺电切手术老年良性前列腺增生患者电解质的干预作用

Effect of hypertonic sodium chloride hydroxyethyl starch 40 on the electrolyte of the elderly patients with benign prostatic hyperplasia in transurethral prostate electrovaporization-ablation

目的研究高渗氯化钠羟乙基淀粉40对行经尿道前列腺电切术(TURP)的老年良性前列腺增生患者电解质的干预作用。方法将60例择期行TURP术的老年良性前列腺增生患者分为乳酸钠林格注射液组和羟乙基淀粉组,每组30例。乳酸钠林格注射液组患者静脉滴注乳酸钠林格注射液;羟乙基淀粉组患者于电切开始后30 min按4 mL.kg-1体质量静脉滴注高渗氯化钠羟乙基淀粉40;随后均用乳酸钠林格注射液维持容量。于输液前、电切开始后30 min和术毕取静脉血检测血电解质K+、Na+、Cl-浓度;统计术中冲洗液用量、手术时间、静脉输液总量;手术前、后秤体质量,计算体质量差。结果 2组冲洗液量、术中输液量及手术时间比较差别均无统计学意义(P>0.05)。乳酸钠林格注射液组血浆K+浓度电切开始后30 min及术毕时低于输液前(P<0.01),羟乙基淀粉组血浆K+浓度术毕时低于输液前(P<0.05),2组间血浆K+浓度比较差别无统计学意义(P>0.05)。乳酸钠林格注射液组血浆Na+浓度电切开始后30 min及术毕时低于输液前(P<0.05),羟乙基淀粉组血浆Na+浓度电切开始后30 min时低于输液前(P<0.01),术毕时则高于输液前(P<0.01);术毕时血浆Na+浓度羟乙基淀粉组明显高于乳酸钠林格注射液组(P<0.01)。2组电切开始30 min时Cl-浓度均低于输液前(P<0.05);术毕时羟乙基淀粉组Cl-浓度高于乳酸钠林格注射液组(P<0.05)。羟乙基淀粉组患者术后体质量增加明显高于乳酸钠林格注射液组(P<0.05)。结论高渗氯化钠羟乙基淀粉40对维持行TURP术老年良性前列腺增生患者血浆Na+浓度有积极作用,有利于减少稀释性低钠血症的发生。

Objective To study the effect of hypertonic sodium chloride hydroxyethyl starch 40 on the electrolyte of the elderly patients with benign prostatic hyperplasia in transurethral prostate electrovaporization-ablation（TURP）.Methods Sixty elderly patients with benign prostatic hyperplasia in TURP were divided into sodium lactate ringer′s injection group and hydroxyethyl starch group,thirty cases in each group.The patients of sodium lactate ringer′s injection group were treated with sodium lactate ringer′s injection.The patients of hydroxyethyl starch group were treated with hypertonic sodium chloride hydroxyethyl starch 40 injection by 4 mL·kg-1 thirty minutes after electrovaporization-ablation,then sodium lactate ringer′s injection was used to hold the capacity in the two groups.Phlebotomize before the transfusion,30 minutes after electrovaporization-ablation and after the operation,the concentration of the blood electrolytes K^＋,Na^＋ and Cl^-were tested,the dosage of the washing solution,duration of surgery and the total dosage of the venous transfusion were recorded,the body weight was weighed before and after the operation,and the balances were calculated.Results The comparison difference of the dosage of the washing solution,total dosage of the venous transfusion and duration of surgery had no statistical significance（P〈0.05）.The concentrations of K^＋ of sodium lactate ringer′s injection group were lower when 30 minutes after the electrovaporization-ablation and after operation than that before the transfusion（P〈0.01）,the concentration of K^＋ of hydroxyethyl starch group after the operation was lower than that before the transfusion（P〈0.05）,the comparison difference of the concentration of K^＋ had no statistical significance between two groups（P〈0.05）.The concentration of Na^＋ in sodium lactate ringer′s injection group was lower when 30 minutes after the electrovaporization-ablation and after operation than that before the transfusion（P〈0.05）.The concentration of Na^＋ of hydroxyethyl starch group was lower when 30 minutes after the electrovaporization-ablation than that before transfusion（P〈0.01）,but it was higher after the operation than that before transfusion（P〈0.01）.The concentration of Na^＋ of hydroxyethyl starch group was obviously higher than that of sodium lactate ringer′s injection group after operation（P〈0.01）.The concentrations of Cl^-when 30 minutes after the electrovaporization-ablation were lower than those before transfusion in two groups（P〈0.05）.After operation,the concentrations of Cl^-in hydroxyethyl starch group was higher than that in sodium lactate ringer′s injection group（P〈0.05）.After the operation,The increasing of body weight in hydroxyethyl starch group was higher than that in sodium lactate ringer′s injection group（P〈0.05）.Conclusion For the old patients with benign prostatic hyperplasia in TURP,hypertonic sodium chloride hydroxyethyl starch 40 has positive effects for holding the concentration of Na^＋ and helps to reduce the incidence of dilutional hyponatremia.