Seif Nazmy E, Shehab Hany A, Elbadawy Ahmed M
Department of Anesthesia, Faculty of Medicine, Cairo University, Giza, Egypt.
Anesth Essays Res. 2020 Jan-Mar;14(1):104-111. doi: 10.4103/aer.AER_148_19. Epub 2020 Feb 25.
This study aimed at investigating the usage and effects of prophylactic hypertonic saline (HS) to prevent the occurrence of transurethral resection of the prostate (TURP) syndrome.
Sixty American Society of Anesthesiologists physical status classes I-III candidates for TURP using the monopolar resectoscope were randomized into three groups 20 patients each. Group A received 4 mL.kg.h HS 3%; Group B received 2 mL.kg.h HS 3%; and Group C received 6 mL.kg.h normal saline. Hemodynamics, vasopressors need, electrolytes (sodium, potassium, and chloride), osmolality, and arterial-blood gas (ABG) were recorded. The incidence of transurethral resection syndrome, intensive care unit (ICU) admission, postoperative ventilation, hospital stay as well as any adverse events were noted.
Hypernatremia was detected in six patients ( = 0.002) of Group A only, while hyponatremia occurred in five patients ( = 0.009) of Group C alone. Serum sodium in Group C showed a significant decrease starting from T2 (1 h postresection) till Tp3 (48 h postoperative). In Group C, five patients experienced hypotension and bradycardia; hypertensive episodes also occurred in five patients and a hypervolemic state was noted in seven patients. TURP syndrome was confirmed in only five patients, all in Group C ( = 0.009). Postoperative ICU admission was needed for seven patients of C Group, five of which required assisted ventilation. The overall hospital stay was longer for Group C patients.
Prophylactic administration of HS during TURP is superior to conventional treatment of an occurred TURP syndrome. Low dose (2 mL.kg.h HS 3%) is effective without adverse effects or risk of contrary hypernatremia.
本研究旨在调查预防性使用高渗盐水（HS）预防经尿道前列腺电切术（TURP）综合征发生的用法及效果。
60例拟行单极电切镜TURP的美国麻醉医师协会身体状况分级为I-III级的患者被随机分为三组，每组20例。A组接受4 mL·kg·h的3% HS；B组接受2 mL·kg·h的3% HS；C组接受6 mL·kg·h的生理盐水。记录血流动力学、血管升压药需求、电解质（钠、钾和氯）、渗透压及动脉血气（ABG）。记录经尿道切除综合征的发生率、重症监护病房（ICU）入住情况、术后通气情况、住院时间以及任何不良事件。
仅A组有6例患者检测到高钠血症（P = 0.002），而仅C组有5例患者发生低钠血症（P = 0.009）。C组血清钠从T2（切除术后1小时）至Tp3（术后48小时）显著下降。C组有5例患者出现低血压和心动过缓；5例患者发生高血压发作，7例患者出现血容量过多状态。仅5例患者确诊为TURP综合征，均在C组（P = 0.009）。C组有7例患者术后需要入住ICU，其中5例需要辅助通气。C组患者的总体住院时间更长。
TURP期间预防性给予HS优于对已发生的TURP综合征的传统治疗。低剂量（2 mL·kg·h的3% HS）有效且无不良反应或高钠血症风险。
