肘静脉压和中心静脉压在经尿道前列腺电切术中的相关性及应用价值研究

Relationship between Elbow Venous Pressure and Central Venous Pressure in Patients Undergoing Transurethral Resection of the Prostate and Its Practical Application Value

目的 评价经尿道前列腺电切术（TURP）患者肘静脉压（EVP）和中心静脉压（CVP）的相关性及应用价值.方法 选取2012年1月-2013年2月在我院行择期TURP患者34例,前列腺增生≥Ⅲ度,美国麻醉医生协会（ASA）分级Ⅰ～Ⅲ级.所有患者首先将单腔中心静脉导管经右颈内静脉置入,随后将静脉留置针置入同侧肘正中静脉,成功后将这两根导管同一个压力传感器连接,分别监测EVP和CVP.患者均采用椎管内麻醉,术中EVP升高超过3 mm Hg者给予预防性治疗.记录患者麻醉前后、截石位前后、术前、术中（随机采集3组数据）、术毕和放下截石位时EVP和CVP;比较患者手术前后血钠变化情况并记录经尿道前列腺电切综合征（TURS）发生情况.结果 共收集到340对压力数据,CVP平均为（6.9±1.4）mm Hg,EVP平均为（7.9±1.4）mm Hg.直线相关分析显示,EVP与CVP呈正相关（r=0.933,P＜0.01）;直线回归方程为CVP=0.934 1×EVP＋0.034 2.患者术后血钠水平低于术前[（133.8±5.6）mmol/L与（140.1±3.6）mmol/L,P＜0.01],但均在参考范围;EVP升高超过3 mm Hg者7例,经处理均未发生TURS.结论 TURP患者EVP与CVP呈高度正相关,在临床中可替代CVP监测用于TURS的预防.

Objective To evaluate the relationship between elbow venous pressure （EVP） and central venous pressure （CVP） in patients undergoing transurethral resection of the prostate （TURP） and its practical application value. Methods 34 patients who undergone elective TURP （prostate enlargement≥ HI degrees, ASA classification： [ I-III grade） in our hospital from January 2012 to February 2013 were selected. The single - lumen central venous catheter was placed via the right internal jugular vein for all patients, then the intravenous trocar were placed in the ipsilateral median elbow vein. The two catheters were connected with one and the same pressure sensor after the above operation was done successfully, EVP and CVP were monitored respectively. All patients received spinal anesthesia and were given preventive treatment if EVP rises above 3 mm Hg. EVP and CVP of patients were recorded before and after anesthesia, before and after lithotomy position, before and after surgery, during surgery （ three groups of data were randomly collected） , and the timepoint when lithotomy position was put down ; Blood sodium levels of patients before and after surgery were compared, and the occurrence of TURS was recorded. Results A total of 340 pairs of pressure data were collected, average CVP was （6. 9 ± 1.4） mm Hg, average EVP was （7.9 ± 1.4） mm Hg, EVP was positively associated with CVP （r = 0. 933, P 〈 0. 01 ） , the linear regression equation was described as CVP = 0. 934 1 × EVP ±0. 034 2. Blood sodium levels of patients after surgery were lower than those before surgery [ （ 133.8 ±5.6） mmol/L vs. （ 140. 1 ± 3.6 ） retool/L, P 〈 0. 01 ] , blood sodium levels of patients before and after surgery were in the normal range. EVP had increased by 3 mm Hg among 7 patients, no TURS occurred after treatment. Conclusion EVP was positively associated with CVP in patients undergoing TURP, it could substitute for CVP monitoring and can be used in prevention of TURS in clinical.