Ryder K W, Olson J F, Kahnoski R J, Karn R C, Oei T O
J Urol. 1984 Nov;132(5):995-7. doi: 10.1016/s0022-5347(17)49984-8.
We report on 2 patients who became deeply comatose after transurethral resection of the prostate. Both patients were severely hyponatremic and hyperammonemic but the course of the comas followed serum ammonia concentrations more closely than serum sodium concentrations. The genitourinary irrigant used in both procedures was a 1.5 per cent glycine solution. Serum amino acid analyses in 1 patient suggested that the postoperative hyperammonemia was due to catabolism of glycine absorbed during surgery. The inadequate activation of normal pathways of ammonia metabolism in this patient may have been caused by a partial deficiency of the urea cycle enzyme argininosuccinate synthetase. We believe that hyperammonemia should be considered as a cause of encephalopathy after transurethral resection of the prostate. The 1.5 per cent glycine genitourinary irrigating solution may not be as nontoxic as generally believed.
我们报告了2例经尿道前列腺切除术后陷入深度昏迷的患者。两名患者均出现严重低钠血症和高氨血症，但昏迷过程与血清氨浓度的关系比与血清钠浓度的关系更为密切。两例手术中使用的泌尿生殖系统灌洗液均为1.5%的甘氨酸溶液。对1例患者的血清氨基酸分析表明，术后高氨血症是由于手术过程中吸收的甘氨酸分解代谢所致。该患者氨代谢正常途径激活不足可能是由于尿素循环酶精氨琥珀酸合成酶部分缺乏所致。我们认为，高氨血症应被视为经尿道前列腺切除术后脑病的一个病因。1.5%的甘氨酸泌尿生殖系统灌洗液可能不像人们普遍认为的那样无毒。
