不同膨宫压力对宫腔镜电切术中患者中心静脉压和血浆电解质变化的影响
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摘要
目的:观察宫腔镜电切术中不同膨宫压力对患者中心静脉压力(CVP)和血浆电解质变化的影响,为避免TURS的发生提供依据。方法:根据术中压力不同将80例宫腔镜电切术按随机方式分为H组(膨宫压力150 mm Hg)和L组(膨宫压力100 mm Hg)两组,膨宫介质均为生理盐水,观察患者入室时(T0)、手术开始后10 min(T1)、术毕(T2)时间段患者CVP和各种电解质血生化指标。结果:两组间血浆电解质指标在监测的各时间点无统计学差异(P>0.05),CVP数值H组比L组上升更加显著,有明显的统计学差异(P<0.05)。结论:在宫腔镜电切术中CVP动态监测对TURS早期诊断有一定的临床意义,使用高膨宫压力的宫腔镜电切术,CVP的升高更为明显,术者须谨慎增加膨宫压,以避免TURS的发生。
Objective: To observe the effects of different distending pressure on central venous pressure( CVP) and plasma electrolyte level in women undergoing hysteroscopic resection for basis to prevent the incidence of transurethral resection syndrome( TURS). Methods: Eighty inpatients undergoing hysteroscopic resection were randomly allocated to two groups according to application of different distending pressure,i. e.,Group H( 150 mm Hg) and Group L( 100 mm Hg). The two groups were managed with physiological saline,and observed concerning the variation of CVP and plasma electrolyte levels at entering the theater( T0),10 min after the operation( T1) and operation completion( T2). Results: Plasma electrolyte levels showed no difference between the two groups at the monitoring point( P > 0. 05),yet the CVP level was increased significantly in group H,which was statistically different( P < 0. 05).Conclusion: Dynamic monitoring over the CVP variation in patients undergoing hysteroscopic resection may be significant for early estimation of TURS.When higher distending pressure is applied,elevated CVP is obvious,suggesting that great attentions should be paid in increasing the pressure to prevent incidence of TURS.
Objective: To observe the effects of different distending pressure on central venous pressure( CVP) and plasma electrolyte level in women undergoing hysteroscopic resection for basis to prevent the incidence of transurethral resection syndrome( TURS). Methods: Eighty inpatients undergoing hysteroscopic resection were randomly allocated to two groups according to application of different distending pressure,i. e.,Group H( 150 mm Hg) and Group L( 100 mm Hg). The two groups were managed with physiological saline,and observed concerning the variation of CVP and plasma electrolyte levels at entering the theater( T0),10 min after the operation( T1) and operation completion( T2). Results: Plasma electrolyte levels showed no difference between the two groups at the monitoring point( P > 0. 05),yet the CVP level was increased significantly in group H,which was statistically different( P < 0. 05).Conclusion: Dynamic monitoring over the CVP variation in patients undergoing hysteroscopic resection may be significant for early estimation of TURS.When higher distending pressure is applied,elevated CVP is obvious,suggesting that great attentions should be paid in increasing the pressure to prevent incidence of TURS.
引文
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[6]VAROL N,MAHER P,VANEAILLIE T,et al.A literature review and updateonthe prevention and management offluid overload inendometrial resection and hystemscopic surgery[J].Gynaecol Endo,2002,11(I):19-26.
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[8]SHIRK GJ.GIMPELSON LU.Control of intrauterine fluid pressure during operative hysteroscopy[J].J Am Assoc Gynecol Laparosc,1994,l(3):229-233.
[9]古博,闵苏.宫腔镜手术的麻醉及电解质、血糖等监测对预防TURS的临床意义[J].重庆医科大学学报,2004,29(6):803-805.
[10]BAHA T,SHIBABA Y,QGATA K,et al.Isotonic hyponatremia and cerebralspinal fluid during and after transurethral resction of prostate[J].Anesth,1995(14):135-141.
[12]周孟虎,包明胜,刘林,等.TURP综合征的预防和治疗[J].临床麻醉学杂志,2009,25(4):312-313.
[2]COOPER JM,BRADY RM.Intra operative and early postoperative complications of operative hystereoscopy[J].Obstetrics and Gynecology Clinics of North America,2000,27(2):347-366.
[3]JANSEN F W.Complications of hysteroscopy:a prospective,multicenter study[J].Obstet Gynecol,2000,96:266-270.
[4]盛卓人,王俊科.实用桩床麻醉学[M].3版.沈阳:辽宁科学技术出版社,1996:562.
[5]夏恩兰.行宫腔镜手术发生严重并发症35例临床分析[J].中华妇产科杂志,2001,36(10):596-599.
[6]VAROL N,MAHER P,VANEAILLIE T,et al.A literature review and updateonthe prevention and management offluid overload inendometrial resection and hystemscopic surgery[J].Gynaecol Endo,2002,11(I):19-26.
[7]VAN KRUCHTEN PM.VERMELIS JI,HEROLD I,et al.Hypertonic and isotonic fluid overload as a complication of hysteroseopic procedures:two cage reports[J].Minerva Anestesiol,2010,76(5):373-377.
[8]SHIRK GJ.GIMPELSON LU.Control of intrauterine fluid pressure during operative hysteroscopy[J].J Am Assoc Gynecol Laparosc,1994,l(3):229-233.
[9]古博,闵苏.宫腔镜手术的麻醉及电解质、血糖等监测对预防TURS的临床意义[J].重庆医科大学学报,2004,29(6):803-805.
[10]BAHA T,SHIBABA Y,QGATA K,et al.Isotonic hyponatremia and cerebralspinal fluid during and after transurethral resction of prostate[J].Anesth,1995(14):135-141.
[12]周孟虎,包明胜,刘林,等.TURP综合征的预防和治疗[J].临床麻醉学杂志,2009,25(4):312-313.