脊髓麻醉下经尿道前列腺切除术与经尿道膀胱肿瘤切除术血流动力学曲线的比较：一项生物阻抗研究

Comparison of hemodynamic profiles in transurethral resection of prostate vs transurethral resection of urinary bladder tumors during spinal anesthesia: a bioimpedance study.

作者信息

Ezri Tiberiu, Issa Nidal, Zabeeda Deeb, Medalion Benjamin, Tsivian Alexander, Zimlichman Reuven, Szmuk Peter, Evron Shmuel

机构信息

Department of Anesthesia, Wolfson Medical Center, affiliated to Sackler Medical School, Tel Aviv University, 58100 Israel.

出版信息

J Clin Anesth. 2006 Jun;18(4):245-50. doi: 10.1016/j.jclinane.2005.12.008.

DOI:10.1016/j.jclinane.2005.12.008

PMID:16797424

Abstract

STUDY OBJECTIVE

Transurethral resection of prostate (TURP) is more frequently associated with perioperative fluid and electrolyte disturbances than transurethral resection of bladder tumors (TURT) because of irrigating fluid absorption. Because fluid overload may cause hypertension, we compared the patients' intraoperative hemodynamic profiles (including the incidence of hypertension) during TURP vs TURT, both performed during spinal anesthesia, by using the bioimpedance method.

DESIGN

Prospective single-blind study.

SETTING

University hospital.

PATIENTS

80 (40 in each group) men, ASA physical status I and II.

INTERVENTIONS

Patients underwent TURP or TURT surgery with spinal anesthesia.

MEASUREMENTS

Mean arterial pressure, heart rate, cardiac index, and systemic vascular resistance were compared between the 2 groups. A mean arterial pressure greater than 30% from the baseline value was considered as hypertension. Plasma sodium was measured preoperatively, intraoperatively, and postoperatively.

MAIN RESULTS

Transurethral resection of prostate patients received more irrigating fluid (7900 +/- 2310 vs 5650 +/- 21560, P < 0.05) and had a higher calculated volume of fluid absorbed: 638 +/- 60 vs 303 +/- 40 mL for the TURT patients (P < 0.05). Mean arterial pressures were higher with TURP, 30 minutes after the onset of surgery and at the end of the procedure (111 +/- 15 vs 100 +/- 10 and 109 +/- 14 vs 99 +/- 14 mmHg, respectively; P < 0.05). However, there was no hypertension in either group. There were no differences in hemodynamic measurements of hyponatremic vs normonatremic patients. Plasma sodium decreased postoperatively more in the TURP group (140.4 +/- 2.6 mEq/L baseline to 134.1 +/- 3.5 mEq/L, P < 0.05) and was lower postoperatively in the TURP group compared with TURT (134.1 +/- 3.5 vs 137.2 +/- 2.9 mEq/L, P = 0.04).

CONCLUSIONS

Although more irrigating fluid was absorbed in the TURP group, there were no episodes of hypertension in either group.

摘要

研究目的

由于冲洗液吸收，经尿道前列腺切除术（TURP）比经尿道膀胱肿瘤切除术（TURT）更常与围手术期液体和电解质紊乱相关。由于液体过载可能导致高血压，我们采用生物阻抗法比较了在脊髓麻醉下进行的TURP与TURT患者术中的血流动力学参数（包括高血压发生率）。

设计

前瞻性单盲研究。

地点

大学医院。

患者

80名男性（每组40名），美国麻醉医师协会（ASA）身体状况分级为I级和II级。

干预措施

患者在脊髓麻醉下接受TURP或TURT手术。

测量指标

比较两组患者的平均动脉压、心率、心脏指数和全身血管阻力。平均动脉压较基线值升高超过30%被视为高血压。术前、术中和术后测量血浆钠浓度。

主要结果

TURP患者接受的冲洗液更多（7900±2310 vs 5650±21560，P<0.05），计算得出的液体吸收量更高：TURT患者为303±40 mL，TURP患者为638±60 mL（P<0.05）。手术开始30分钟后及手术结束时，TURP患者的平均动脉压更高（分别为111±15 vs 100±10和109±14 vs 99±14 mmHg；P<0.05）。然而，两组均未出现高血压。低钠血症患者与正常钠血症患者的血流动力学测量结果无差异。TURP组术后血浆钠下降更多（基线值140.4±2.6 mEq/L降至134.1±3.5 mEq/L，P<0.05），且TURP组术后血浆钠低于TURT组（134.1±3.5 vs 137.2±2.9 mEq/L，P = 0.04）。