Heyns C F, Rittoo D, Sutherland G R, Davie I T, Scott N B, Chisholm G D
Department of Surgery/Urology, Western General Hospital, Edinburgh.
Br J Urol. 1993 Jun;71(6):716-20. doi: 10.1111/j.1464-410x.1993.tb16072.x.
Recent studies have shown an increased late mortality rate due to cardiovascular causes after transurethral compared with open prostatectomy. This has been linked to the demonstration of haemodynamic changes during transurethral prostatectomy, which may cause ischaemic myocardial injury. We used transoesophageal echocardiography (currently the most sensitive modality for detecting myocardial ischaemia) to study 26 patients during prostatectomy under general anaesthesia. Evidence of myocardial ischaemia (as shown by the development of new regional wall motion abnormalities of the left ventricle) occurred in 4 of 22 patients during transurethral and in 3 of 4 patients during retropubic prostatectomy. An intra-operative fall in systolic as well as diastolic blood pressure occurred in 21 of 22 patients during the transurethral procedure and in all 4 patients during retropubic prostatectomy. The duration of anaesthesia and the operation, and the intra-operative blood loss did not differ significantly between patients with and without evidence of intra-operative myocardial ischaemia. However, the maximum intra-operative fall in systolic and diastolic blood pressure, as well as the mass of the prostatic tissue removed, were significantly greater in patients with than in those without evidence of intra-operative myocardial ischaemia, suggesting that the latter may be related to the extent of surgery and the degree of intraoperative hypotension. In this study, 7 of 26 patients (27%) showed evidence of myocardial ischaemia during prostatectomy. However, it remains difficult to explain why intra-operative myocardial ischaemia should result in an increased cardiovascular mortality rate several years after the operation.
最近的研究表明，与开放性前列腺切除术相比，经尿道前列腺切除术后因心血管原因导致的晚期死亡率有所增加。这与经尿道前列腺切除术中血流动力学变化的表现有关，这种变化可能会导致缺血性心肌损伤。我们使用经食管超声心动图（目前检测心肌缺血最敏感的方法）对26例在全身麻醉下进行前列腺切除术的患者进行了研究。在经尿道前列腺切除术过程中，22例患者中有4例出现心肌缺血证据（表现为左心室新出现的局部壁运动异常），在耻骨后前列腺切除术过程中，4例患者中有3例出现心肌缺血证据。在经尿道手术过程中，22例患者中有21例出现术中收缩压和舒张压下降，在耻骨后前列腺切除术过程中，所有4例患者均出现这种情况。有术中心肌缺血证据和无术中心肌缺血证据的患者之间，麻醉和手术持续时间以及术中失血量没有显著差异。然而，有术中心肌缺血证据的患者术中收缩压和舒张压的最大降幅以及切除的前列腺组织量，均显著大于无术中心肌缺血证据的患者，这表明后者可能与手术范围和术中低血压程度有关。在本研究中，26例患者中有7例（27%）在前列腺切除术过程中出现心肌缺血证据。然而，术后数年术中心肌缺血为何会导致心血管死亡率增加，仍然难以解释。
