Manikandan Ramaswamy, Nathaniel Calvin, Lewis Phillip, Brough Richard J, Adeyoju Adebanji, Brown Stephen C W, O'Reilly Patrick H, Collins Gerald N
Department of Urology, Stepping Hill Hospital, Stockport, United Kingdom.
J Urol. 2005 Nov;174(5):1892-5; discussion 1895. doi: 10.1097/01.ju.0000177496.51808.4a.
We investigated whether transurethral resection of the prostate (TURP) caused subclinical myocardial damage or cardiac dysfunction by measuring troponin T (Trop T) and N-terminal pro-brain natriuretic peptide (pro-BNP).
A total of 52 consenting patients took part in this study. All had a detailed medical history including cardiac history taken. On the day of the operation all patients had troponin T, pro-BNP, full blood count and urea, electrolytes and creatinine measured preoperatively. A preoperative and postoperative electrocardiogram was performed. Patients in renal failure were excluded from analysis. During the operations factors such as blood loss, operative time, tissue resected and fluid absorption were monitored. On postoperative day 1 all the previously mentioned tests were repeated.
Mean patient age was 71 years (range 52 to 85). Eight patients had a history of associated cardiac problems. Mean preoperative and postoperative hemoglobin were 14.1 gm/dl (range 10.5 to 17) and 13.3 gm/dl (range 9.9 to 16.2), respectively. None of the patients had significant (greater than 1,000 ml) fluid absorption during TURP, which was calculated using ethanol tagged glycine. Mean blood loss measured with a photometer was 129.7 ml (range 0 to 1,800). Mean operative time was 28.4 minutes (range 5 to 50) and mean weight of prostatic tissue resected was 15.2 gm (range 1 to 47). Preoperative Trop T was less than 0.01 mcg/ml in all patients and mean pro-BNP was 39.2 pg/ml (range 0.5 to 866). Postoperative Trop T was less than 0.01 mcg/ml in all but 1 patient who experienced chest pain after TURP and had an increased Trop T (0.28 mcg/ml). Mean postoperative pro-BNP was 54.57 pg/ml (range 1 to 679). A total of 37 patients had an increase in pro-BNP which was still within the reference range for the age group. There were no significant electrocardiogram changes postoperatively. The Trop T changes were not statistically significant (Wilcoxon sign ranked test p = 0.31) although they may be clinically significant.
Our study indicates that in patients with no prior cardiac history TURP does not cause myocardial damage indicated by nonincrease of Trop T. There are slight increases in pro-BNP after TURP in some patients although the exact clinical significance is uncertain.
我们通过测量肌钙蛋白T（Trop T）和N末端脑钠肽前体（pro-BNP），研究经尿道前列腺切除术（TURP）是否会导致亚临床心肌损伤或心脏功能障碍。
共有52名同意参与的患者参加了本研究。所有患者均有详细的病史记录，包括心脏病史。手术当天，所有患者术前均测量了肌钙蛋白T、pro-BNP、全血细胞计数以及尿素、电解质和肌酐。同时进行了术前和术后心电图检查。肾衰竭患者被排除在分析之外。手术过程中监测了失血、手术时间、切除组织量和液体吸收等因素。术后第1天重复进行上述所有检查。
患者平均年龄为71岁（范围52至85岁）。8名患者有相关心脏问题病史。术前和术后血红蛋白平均值分别为14.1 g/dl（范围10.5至17）和13.3 g/dl（范围9.9至16.2）。使用乙醇标记甘氨酸计算得出，TURP期间无患者有大量（超过1000 ml）液体吸收。用光度计测量的平均失血量为129.7 ml（范围0至1800）。平均手术时间为28.4分钟（范围5至50），切除前列腺组织的平均重量为15.2 g（范围1至47）。所有患者术前Trop T均小于0.01 mcg/ml，pro-BNP平均值为39.2 pg/ml（范围0.5至866）。除1名TURP后出现胸痛且Trop T升高（0.28 mcg/ml）的患者外，其余患者术后Trop T均小于0.01 mcg/ml。术后pro-BNP平均值为54.57 pg/ml（范围1至679）。共有37名患者的pro-BNP升高，但仍在该年龄组的参考范围内。术后心电图无明显变化。Trop T变化虽可能具有临床意义，但差异无统计学意义（Wilcoxon符号秩和检验p = 0.31）。
我们的研究表明，对于无既往心脏病史的患者，TURP不会导致Trop T未升高所提示的心肌损伤。部分患者TURP后pro-BNP略有升高，但其确切临床意义尚不确定。
