Tsao C M, Lui P W, Jang J H, Kong P M, Shu C C, Chang D S, Lee T Y
Department of Anesthesiology, Veterans General Hospital-Taipei.
Acta Anaesthesiol Sin. 1996 Dec;34(4):185-90.
Diuretic therapy after transurethral prostatectomy (TURP) is primarily intended to induce diuresis against water intoxication and cystic clot retention. This study was undertaken to compare the diuretic effects of glycerol with furosemide after TURP.
Thirty patients (ASA I or II) undergoing TURP were studied. Spinal anesthesia was induced with bupivacaine. At the end of prostatic resection, the patients were randomly allocated into two groups. In one group (n = 15) the patients received furosemide 30 mg i.v., while in the other group (n = 15) they received glycerol 0.5 g/kg i.v. Blood samples were collected for measurements of osmolality, hematocrit, sodium and glucose concentration before anesthesia and after surgery. Urine output was also recorded after surgery in each group.
Plasma osmolality in glycerol group was higher than furosemide group at 30 min (295.3 +/- 10.6 vs. 283.8 +/- 5.6 mOsm/kg, p < 0.01) and 1 h after operation (294.9 +/- 8.7 vs 286.3 +/- 6.7 mOsm/kg, p < 0.01). Blood glucose was higher in glycerol group than that in furosemide group at 2 h after operation (195.6 +/- 121.9 vs 152.9 +/- 70.1 mg/dl, p < 0.05). Measured urine output was significantly greater in furosemide group at 30 min after operation (904.6 +/- 491.5 vs. 248.4 +/- 143.4 ml, p < 0.05) but was greater in glycerol group at 12 h after operation.
Since urine output is significantly less in glycerol group at 1 h after operation, glycerol is inferior to furosemide for preventing cystic clot retention after TURP. But glycerol may protect against water intoxication better for its merit of producing higher plasma osmolality.
经尿道前列腺切除术（TURP）后的利尿治疗主要旨在针对水中毒和膀胱血块潴留诱导利尿。本研究旨在比较TURP后甘油与呋塞米的利尿效果。
对30例接受TURP的患者（ASA I或II级）进行研究。用布比卡因诱导脊髓麻醉。在前列腺切除结束时，将患者随机分为两组。一组（n = 15）患者静脉注射30 mg呋塞米，而另一组（n = 15）患者静脉注射0.5 g/kg甘油。在麻醉前和手术后采集血样以测量渗透压、血细胞比容、钠和葡萄糖浓度。每组术后也记录尿量。
甘油组术后30分钟（295.3±10.6 vs. 283.8±5.6 mOsm/kg，p < 0.01）和1小时（294.9±8.7 vs 286.3±6.7 mOsm/kg，p < 0.01）时血浆渗透压高于呋塞米组。术后2小时甘油组血糖高于呋塞米组（195.6±121.9 vs 152.9±70.1 mg/dl，p < 0.05）。术后30分钟呋塞米组实测尿量显著多于甘油组（904.6±491.5 vs. 248.4±143.4 ml，p < 0.05），但术后12小时甘油组尿量更多。
由于甘油组术后1小时尿量明显较少，在TURP后预防膀胱血块潴留方面甘油不如呋塞米。但甘油因其能产生较高的血浆渗透压，可能在预防水中毒方面更具优势。
