摘要
背景过去，血清钠离子浓度的降低是诊断经尿道前列腺切除术（transurethralresectionoftheprostate，TURP）冲洗液（不含电解质）吸收的诊断标准。在使用双极的TURP中，冲洗液包含了电解质，所以不能依赖血钠浓度来判断冲洗液是否吸收。在本研究中，我们观察了在使用双极的TURP手术中葡萄糖能否成为冲洗液吸收的诊断标准。方法选取250例使用单极行TURP手术的患者，术中膀胱冲洗液为1．5％的甘氨酸或5％的葡萄糖溶液，检测血糖和血钠浓度。选取10名志愿者，持续输注含1％葡萄糖的醋酸林格液（20ml／kg）30分钟，进行葡萄糖代谢动力学分析。计算机通过采集的数据模拟出不同的吸收模式，以列线图总结出葡萄糖浓度和输注液体容量的关系。结果在TURP中5％葡萄糖灌洗液冲洗后，血钠降低，血糖升高，呈明显的负线性关系（r2=0．80）。在冲洗过程中血糖逐渐升高，从4．6（标准差0．4）mmol／L升高至8．3（0．9）mmol／L。无论何种吸收模式均显示体内摄取1L含1％葡萄糖的冲洗液血糖相应的升高3．7（SD1．6）mmol／L，摄取2L冲洗液血糖升高6．9（1．7）mmol／L。结论在使用单极的TURP中，通过检测血钠浓度来观察冲洗液吸收情况，与之相比较，在使用双极的TURP中，含有电解质的冲洗液中加入1％的葡萄糖，可以成为检测冲洗液吸收情况的标记物。
BACKGROUND： Historically, a reduced serum sodium concentration has been used to diagnose absorption of electrolyte-free irrigating fluid during transurethral resection of the prostate （TURP）. In bipolar TURP, the irrigating solution contains electrolytes, thus invalidating the serum sodium method. In this study, we investigated whether glucose can be used to diagnose the absorption of irrigating fluid during TURP procedures. ~ODS： The serum glucose and sodium concentrations were measured in 250 patients undergoing monopolar TURP using either 1.5% glycine or 5% glucose for urinary bladder irrigation. The glucose ldnetics was analyzed in 10 volunteers receiving a 30-min infusion of 20 ml/kg of acetated Ringer＇s solution with 1% glucose. These data were then used in computer simulations of different absorption patterns that were summarized in a nomogram for the relationship between the glucose level and administered fluid volume. RESULTS： There was a statistically significant inverse linear relationship between the decrease in serum sodium and the increase in glucose levels after absorption of 5% glucose during TURP （r2 =0. 80）. The glucose concentration increased, from 4. 6 （SD 0. 4） to 8. 3 （0. 9） retool/L, during the experimental infusions. Regardless of the absorption pattern, all simulations indicated that the uptake of 1 L of fluid containing 1% glucose corresponded to an increase in the glucose level of 3. 7 （SD 1.6） mmol/L at the end of surgery, whereas 2 L yielded an increase of 6. 9 （1.7） mmol/L. CONCLUSIONS： In bipolar TURP, the addition of glucose to a concentration of 1% in the electrolyte-containing irrigation fluid can be used as a tracer of absorption that is comparable with measuring serum sodium after monopolar TURP.
出处
《麻醉与镇痛》
2013年第5期83-89,共7页
Anesthesia & Analgesia
