Kuroda Yasuko, Kamitani Kazuo, Yoshida Hitoshi, Miyoshi Harumi, Kishi Riho, Sato Miki, Mutsuura Koso, Asahi Takehisa
Department of Anesthesiology, Toyama Prefectual Central Hospital, Toyama 930-8550.
Masui. 2010 Apr;59(4):464-6.
We report a case of transurethral resection of prostate (TURP) syndrome with severe hyponatremia (98 mEq x l(-1)). A relatively healthy 71-year-old man (167 cm and 61 kg) with benign prostatic hypertrophy was scheduled for transurethral resection of the prostate under general anesthesia. Ninety minutes after starting the operation, electrolyte analysis revealed a decrease in serum Na concentration (Na 98 mEq x l(-1), BE -6.4), and 7% NaHCO3 60 ml + saline 500 ml were rapidly administered, and saline 500 ml + 10% NaCl 60 ml were administered at a rate of 100 ml per hour (Na 32 mEq x hr(-1)). One hour later, serum Na concentration was 111 mEq x l(-1). No ECG changes were observed during TURP. No neurological signs were observed, postoperatively. Central pontine myelinolysis (CPM) has been associated with excessively rapid correction of chronic hyponatremia. However, the pathophysiology of chronic hyponatremia is different from that of acute hyponatremia. Central pontine myelinolysis has not yet been reported after correction of acute hyponatremia in the TURP patient. Acute hyponatremia during TURP should be corrected rapidly, because acute hyponatremia can cause neurological complications.
我们报告一例经尿道前列腺切除术（TURP）综合征伴严重低钠血症（98 mEq×l⁻¹）的病例。一名相对健康的71岁男性（身高167 cm，体重61 kg），患有良性前列腺增生，计划在全身麻醉下进行经尿道前列腺切除术。手术开始90分钟后，电解质分析显示血清钠浓度降低（钠98 mEq×l⁻¹，碱剩余-6.4），迅速给予7%碳酸氢钠60 ml加生理盐水500 ml，并以每小时100 ml的速度给予生理盐水500 ml加10%氯化钠60 ml（钠32 mEq×hr⁻¹）。1小时后，血清钠浓度为111 mEq×l⁻¹。TURP过程中未观察到心电图变化。术后未观察到神经体征。中枢桥脑髓鞘溶解症（CPM）与慢性低钠血症的过度快速纠正有关。然而，慢性低钠血症的病理生理学与急性低钠血症不同。TURP患者急性低钠血症纠正后尚未有中枢桥脑髓鞘溶解症的报道。TURP期间的急性低钠血症应迅速纠正，因为急性低钠血症可导致神经并发症。
