Scherhag A, Elich D, Heinrichs W
Klinik für Anästhesiologie der Johannes Gutenberg-Universität, Mainz.
Anaesthesist. 1995 Jun;44(6):436-41. doi: 10.1007/s001010050173.
The absorption of large volumes of irrigation fluid is a major problem in transurethral prostatic surgery (TUR-P). Various indicators have been tested to monitor fluid absorption with regard to continuous registration and sufficient accuracy. The volumetric fluid balance is not suitable as a routine method because of its inaccuracy. Easily accessible parameters are unspecific because of surgical bleeding (haematocrit [Hct]), or are interfered with by physiological counter-regulatory actions (serum sodium [Na] concentration). In 1986 Hulten et al. suggested adding 2% ethanol to the irrigation fluid as a marker and investigated it intermittently in the expired air with an alcohol-test appliance. In a prospective clinical study of 17 patients undergoing TUR-P under spinal anaesthesia, expiratory concentrations of alcohol that was added to the irrigation fluid (2% ethanol in Purisole, Fresenius, Bad Homburg) were monitored. Gas was continuously sampled from the nasopharynx through a nasal cannula and the ethanol concentration was measured using a modified diverting anaesthetic gas monitor (Normac, Datex, Helsinki) that allows continuous as well as early detection of the absorbed irrigation fluid with reliable accuracy for clinical use. In addition, at intervals of 10 minutes we measured blood alcohol, end-tidal alcohol (Alcotest 7110, Dräger, Lübeck), haematocrit, serum Na concentration, and blood gases. Sixty-eight measurements were obtained from the 17 patients. As shown in other studies, serum Na (r2 = 0.68) and Hct (r2 = 0.39) correlated poorly with the irrigation fluid as determined by serum alcohol levels. In contrast, the expiratory alcohol measurements with the Alcotest 7110 (r2 = 0.93) and Normac devices (r2 = 0.85) were closely related. Continuous monitoring of the expiratory alcohol concentration with a Normac monitor closely reflects blood alcohol concentration, and may hence serve as a useful semiquantitative monitor of irrigation fluid absorption during TUR-P.
大量灌洗液的吸收是经经经尿道前列腺切除术（TUR-P）中的一个主要问题。已经测试了各种指标来监测液体吸收情况，以实现连续记录并具备足够的准确性。容量性液体平衡由于其不准确性，不适合作为常规方法。易于获取的参数因手术出血（血细胞比容[Hct]）而缺乏特异性，或者会受到生理代偿调节作用（血清钠[Na]浓度）的干扰。1986年，胡尔滕等人建议在灌洗液中添加2%的乙醇作为标记物，并使用酒精测试仪器在呼出气体中间歇性地进行检测。在一项对17例接受脊髓麻醉下TUR-P手术患者的前瞻性临床研究中，监测了添加到灌洗液中的乙醇（2%乙醇溶于Purisole，费森尤斯公司，巴特洪堡）的呼气浓度。通过鼻导管从鼻咽部连续采集气体，并使用改良的分流麻醉气体监测仪（Normac，Datex公司，赫尔辛基）测量乙醇浓度，该监测仪能够以可靠的准确性连续且早期地检测出吸收的灌洗液，适用于临床。此外，每隔10分钟我们测量血醇、呼气末乙醇（Alcotest 7110，德尔格公司，吕贝克）、血细胞比容、血清钠浓度和血气。从这17例患者中获得了68次测量数据。如其他研究所示，血清钠（r2 = 0.68）和血细胞比容（r2 = 0.39）与通过血清乙醇水平确定的灌洗液相关性较差。相比之下，使用Alcotest 7110（r2 = 0.93）和Normac设备进行的呼气乙醇测量结果密切相关。使用Normac监测仪连续监测呼气乙醇浓度能密切反映血醇浓度，因此可作为TUR-P手术期间灌洗液吸收的有用半定量监测指标。
