Evans J W, Singer M, Chapple C R, Macartney N, Walker J M, Milroy E J
Department of Urology, Middlesex Hospital, London.
BMJ. 1992 Mar 14;304(6828):666-71. doi: 10.1136/bmj.304.6828.666.
To compare haemodynamic performance during transurethral prostatectomy and non-endoscopic control procedures similar in duration and surgical trauma.
Controlled comparative study.
London teaching hospital.
33 men aged 50-85 years in American Society of Anesthesiologists risk groups I and II undergoing transurethral prostatectomy (20), herniorrhaphy (eight), or testicular exploration (five).
Percentage change from baseline in mean arterial pressure, heart rate, Doppler indices of stroke volume and cardiac output, and index of systemic vascular resistance, and change from baseline in core temperature.
In the control group mean arterial pressure fell to 11% (95% confidence interval -17% to -5%) below baseline at two minutes into surgery and remained below baseline; there were no other overall changes in haemodynamic variables and the core temperature was stable. During transurethral prostatectomy mean arterial pressure increased by 16% (5% to 27%) at the two minute recording and remained raised throughout. Bradycardia reached -7% (-14% to 1%) by the end of the procedure. Doppler indices of stroke volume fell progressively to 15% (-24% to -6%) below baseline at the end of the procedure, and the index of cardiac output fell to 21% (-32% to -10%) below baseline by the end of the procedure. The index of systemic vascular resistance was increased by 28% (17% to 38%) at two minutes, and by 46.8% (28% to 66%) at the end of the procedure. Core temperature fell by a mean of 0.8 (-1.0 to -0.6) degrees C. Significant differences existed between the two groups in summary measures of mean arterial pressure (p less than 0.05), Doppler indices of stroke volume (p less than 0.005) and cardiac output (p less than 0.005), index of systemic vascular resistance (p less than 0.0005), and core temperature (p less than 0.0001).
Important haemodynamic disturbances were identified during routine apparently uneventful transurethral prostatectomy but not during control procedures. These responses may be related to the rapid central cooling observed during transurethral prostatectomy and require further study.
比较经尿道前列腺切除术与持续时间和手术创伤相似的非内镜对照手术期间的血流动力学表现。
对照比较研究。
伦敦教学医院。
33名年龄在50 - 85岁之间、美国麻醉医师协会风险分级为I级和II级的男性，接受经尿道前列腺切除术（20例）、疝修补术（8例）或睾丸探查术（5例）。
平均动脉压、心率、每搏量和心输出量的多普勒指数、全身血管阻力指数相对于基线的变化百分比，以及核心体温相对于基线的变化。
在对照组中，手术两分钟时平均动脉压降至基线以下11%（95%置信区间为-17%至-5%），并一直低于基线；血流动力学变量无其他总体变化，核心体温稳定。在经尿道前列腺切除术期间，两分钟记录时平均动脉压升高了16%（5%至27%），并在整个过程中持续升高。手术结束时心动过缓达到-7%（-14%至1%）。手术结束时每搏量的多普勒指数逐渐降至基线以下15%（-24%至-6%），心输出量指数在手术结束时降至基线以下21%（-32%至-10%）。全身血管阻力指数在两分钟时升高了28%（17%至38%），在手术结束时升高了46.8%（28%至66%）。核心体温平均下降了0.8（-1.0至-0.6）摄氏度。两组在平均动脉压（p<0.05）、每搏量多普勒指数（p<0.005）、心输出量（p<0.005）、全身血管阻力指数（p<0.0005）和核心体温（p<0.0001）的综合测量指标上存在显著差异。
在常规的看似平稳的经尿道前列腺切除术中发现了重要的血流动力学紊乱，但在对照手术中未发现。这些反应可能与经尿道前列腺切除术期间观察到的快速中枢性体温下降有关，需要进一步研究。
