肘静脉压监测在经尿道前列腺电切术中的应用

The Applications Elbow vein pressuremonitoring in transurethral resection

目的 评价肘静脉压（EVP）监测在经尿道前列腺电切术（TURP）中应用的可行性.方法 选择2010年1月～2012年12月哈励逊国际和平医院TURP患者185例,年龄62～ 81岁,前列腺增生Ⅲ°以上,美国麻醉医师协会（ASA）分级Ⅰ～Ⅱ级;采用随机数字表法将患者分为中心静脉压组（CVP组,n=92）和肘静脉压组（EVP组,n=93）.CVP组行中心静脉穿刺置管,EVP组行肘正中静脉穿刺置管,成功后连续监测CVP和EVP.两组患者如果术中静脉压升高超过3mm Hg,告知外科医生尽快结束手术并调整灌洗液悬挂高度;给予患者静脉注射速尿20 mg并静脉滴注3％高渗氯化钠200 mL;行血气电解质分析并根据分析结果对症处理.记录CVP组和EVP组静脉压变化情况、TURS发生率及血钠情况.采用SPSS19.0软件进行统计学处理及绘图.结果 两组术毕血钠较术前均降低（P＜0.05）但均在正常范围,组间比较差异无统计学意义（P＞0.05）;两组均无经尿道前列腺电切综合征（TURS）发生;两组患者静脉压变化趋势一致.结论 TURP术中行肘静脉压监测可以指导优化治疗,减少TURS发生,临床应用可行.

Objectives To evaluate the feasibility that the elbow venous pressure （EVP） monitoring applied in the transurethral resection（TURP）.Methods From January 2010 to December 2012 in Harrison International Peace Hospital,selected 185 cases of TURP patients,aged from 62 to 81 years,benign prostatic hyperplasia Ⅲ degrees,ASA Ⅰ ～ Ⅱ grade.Patients were divided into central venous pressure group（CVP group,n =92） and Elbow vein pressuregroup（EVP group,n =93） using a random number table method.CVP group underwent central venous catheterization and EVP group underwent median cubital vein catheterization,then continuous monitored CVP and EVP after successful puncture.If the patients of the two groups＇ venous pressure exceeded 3 mmHg intraoperative,informed the surgeon that ended the surgery as soon as possible and adjusted the fluid suspension height.Gave patients furosemide 20 mg intravenous and intravenous infusion of 3％ hypertonic saline 200 ml.Blood gas and electrolyte analysis should be done and then symptomatic treated according the results.Record CVP group and EVP group＇s venous pressure changes,TURS incidence and sodium circumstances.SPSS19.0 software was used for statistical analysis and graphics.Results The two groups＇ serum sodium after surgery were lower than the preoperative（P ＜ 0.05）and within the normal range.The difference between groups was not statistically significant（P ＞0.05） ; There were no transurethral resection syndrome （TURS） occurred;The two groups＇ venous pressure were in the same trend.Conclusions Elbow vein pressuremonitoring in TURP can optimize treatment,reduce TURS occurrence.Clinical application is feasible.