Neurological Department, Ospedale Cardinal Massaia, Asti, Italy.
Acta Neurol Belg. 2011 Jun;111(2):152-4.
Postoperative delirium is one of the most spectacular, frightening and misdiagnosed postoperative complications of surgery. We describe the case of a caucasian 77-year-old male patient, who developed a severe postoperative delirium after combined transurethral resection of the prostate and cystolithotripsy. This systemic and unpredictable complication of endoscopic surgery is caused by excessive absorption of electrolyte-free irrigation fluids, leading to brain edema and metabolic encephalopathy. The clinical spectrum ranges from asymptomatic hyponatraemia, to electrocardiographic (ECG) changes, nausea, vomiting, convulsions, coma, pulmonary edema, cardiovascular compromise and death. Because of the heterogeneous clinical presentation diagnosis can be difficult. In a patient who develops alterations of consciousness with evidence of hypervolemia and hyponatremia after endoscopic surgery, transurethral resection syndrome must be considered.
术后谵妄是手术最显著、最可怕且易误诊的术后并发症之一。我们描述了一例 77 岁白人男性患者的病例，该患者在接受经尿道前列腺切除术和膀胱结石碎石术后出现严重的术后谵妄。这种内镜手术的系统性和不可预测的并发症是由无电解质灌洗液的过度吸收引起的，导致脑水肿和代谢性脑病。其临床谱从无症状性低钠血症到心电图 (ECG) 改变、恶心、呕吐、抽搐、昏迷、肺水肿、心血管功能障碍和死亡不等。由于临床表现异质性，诊断可能较为困难。对于内镜手术后出现意识改变并伴有血容量过多和低钠血症的患者，必须考虑经尿道切除综合征。
