良性前列腺增生患者经尿道前列腺电切术水中毒预防与治疗的方法探讨

Effective method in the prevention and treatment of water intoxication of patients with benign prostatic hyperplasia during transurethral resection

目的:探讨良性前列腺增生(BPH)患者经尿道前列腺电切术水中毒预防与治疗的有效方法。方法:选取我院2014年5月至2016年5月收治的良性前列腺增生(BPH)患者100例,其中3例患者术中发生水中毒,水中毒发生率为3%,给予患者脱水利尿治疗,途径为对患者应用20%甘露醇,对高渗钠进行补充,将酸中毒及低血压纠正过来,膀胱前或腹腔间隙穿刺对积液进行引流,以将手术尽可能快地中止或结束,然后分析其治疗效果。结果:3例水中毒患者中,具有正常电解质、以较快的速度纠正生命体征、排除膀胱周围及腹腔间隙积液、没有对手术进程造成影响2例,具有正常的生命体征的时间为治疗1h左右后而将手术中止1例。回病房后均具有较为稳定的生命体征,术中输血400mL 1例,术后输血400mL 1例。术后1~3d、5d分别停止冲洗膀胱并将膀胱造瘘管拔除、将导尿管拔除出院。3例患者术后1个月均具有令人满意的排尿且没有显著并发症发生。结论:早期发现和治疗是BPH患者经尿道前列腺电切术水中毒预防与治疗的有效方法,值得临床充分重视。

Objectives： To investigate the effective method in the prevention and treatment of water intoxication of patients with benign prostatic hyperplasia（BPH） during transurethral resection. Methods： 100 patients with BPH who were treated in our hospital from May 2014 to May 2016 were selected,including 3 patients undergoing water intoxication,an incidence of 3%. The patients were given dehydration diuretic therapy,20% mannitol for hypertonic sodium supplement,to correct the acidosis and low blood pressure. Then the bladder or abdominal puncture effusion drainage surgery was performed as quickly as possible to suspend or complete the surgery. The therapeutic effect was analyzed. Results： Two of the three patients with water intoxication had normal electrolytes and the vital signs were corrected and bladder and peritoneal fluid were excluded timely thusly having no impact on the operation process. The other patient had normal vital signs whose surgery was suspend approximately 1h later. All the three patients had relatively stable vital signs back to the ward,and 400 ml of intraoperative and postoperative transfusion was in one case respectively. The flushing of the bladder was stopped 1-3d and bladder fistula was removed5 d after operation. All the three patients had satisfactory urination and no significant complications a month after treatment. Conclusion： Early detection and treatment is effective in the prevention and treatment of water intoxication of patients with BPH during transurethral resection,which should be paid more attention in clinical.