冲洗液控温对经尿道前列腺电切术患者血浆D二聚体、选择素P和选择素E的影响

Effects of perioperative hypothermia on change of the serum level of D-dimer, P-selectin and E-selectin during TURP

目的探讨经尿道前列腺电切术（TURP）过程中，控制术中、术后膀胱冲洗液温度对血浆D二聚体，选择素P和选择素E变化的影响。方法2009年4月～2010年4月，收治拟行TURP的前列腺增生患者80例，按数字随机法分为温控组（A组）和室温组（B组）各40例。同时，选择10例同年龄组正常男性体检者作为无手术对照组（c组）。测定受试者术前30min，术中15、30、45及60min和术后30及60min中心体温。采用ELISA方法检测受试者术前1h，术后1、6、12、24、36和72h的血浆D二聚体（D—dimer），选择素P（P—selectin），选择素E（E—selectin），比较不同时间的各项指标变化。结果B组患者从术中45min开始至术后60min中心体温明显下降；与A组比较差异有显著性（P〈0．01）。而A组中心体温与C组比较差异无显著性（P〉0．05）。B组血浆D二聚体、选择素P和选择素E分别于术后36、6和1h达到峰值，与A组比较，3项指标均显著增高（P〈0．01）。结论前列腺电切术时通过对冲洗液的控温可使患者中心体温保持稳定；使D二聚体，选择素P和选择素E的升幅降低，提示控温可能减少前列腺术后血栓前状态和深静脉血栓的发生。

[ Objective ] To evaluate the change of unwarmed and warmed irrigation fluid on the serum level of D-direct, P-selectin and E-selectin during transurethral resection of the prostate（TURP）. [Methods] A total of 80 patients were randomly divided into 2 groups according to the temperature of irrigation fluid during TURP. Tempera- ture of irrigation fluid in warmed group （group A, n=40） is 37℃ and temperature of irrigation fluid in unwarmed group （group B, n-40） is 25℃, and 10 non-operative patients （group C, n=10） were enrolled in the study as a control group. Pre-operatively, the age and body weight were not significantly different between group A and B. The pa- tients＇s anal temperature was recorded at 30 minute before operation, 15 minute, 30 minute, 45 minute, 60 minute in operation and 30 minute, 60 minute after operation. The serum level of D-dimer, P-seleetin and E-selectin were measured in 1 hours before surgery, and in 1 hours, 6 hours, 12 hours, 24 hours, 36 hours, 72 hours after operation. [ Results] After 60 rain in the process of TURP, The patients＇s anal temperature in unwarmed group （group B） was significantly lower compared with warmed group （group A） （P 〈0.01）. The serum level of D-dimer, was the hightest in 36 hours [group A was （501±54） ng/mL, group B was （845±82） ng/mL, group C was （165±17） ng/mL], theserum level of P-selectin was the hightest in 6 hours [group A was （37.02±4.40） ng/mL, group B was （49.82±4.45） ng/mL, group C was （10.29±1.23） ng/mL] and the serum level of E-selectin was the hightest in 1 hours [group A was （36.39±3.19） ng/mL, group B was （51.26±4.20） ng/mL, group C was （22.07±2.21） ng/mL] after surgery. The serum indicators in group A compared with group B was significantly lower（P 〈0.01）. [Conclusions] The patients＇s anal temperature was stable in warmed group. D-dimer, P-seleetin and E-selectin was significantly lower in A group compared with B group. Its Suggest that warming temperature of irrigation fluid can prevented of prostate postopera- tive prothrombotic state and deep vein thrombosis occurred.