文章摘要
经食管超声多普勒在经尿道前列腺电切术患者早期诊治前列腺电切综合征中的应用
Application of transesophageal doppler mornitoring in early diagnosis and treatment of transurethral resection syndrome in patients undergoing transurethral resection prostate
  
DOI：
中文关键词: 经食管超声多普勒  经尿道前列腺电切术  前列腺电切综合征  校正血流时间  中心静脉压
英文关键词: Transesophageal doppler  Transurethral resection prostate  Transurethral resection syndrome  Corrected flowtimee  Central venouse pressure
基金项目:安徽省自然科学基金资助项目（1408085MH187）
作者单位E-mail
章蔚 230001,合肥市,安徽省立医院麻醉科  
王家武 230001,合肥市,安徽省立医院麻醉科  
柴小青 230001,合肥市,安徽省立医院麻醉科 zw97079@163.com 
魏昕 230001,合肥市,安徽省立医院麻醉科  
吴运香 230001,合肥市,安徽省立医院麻醉科  
马骏 230001,合肥市,安徽省立医院麻醉科  
栾远航 230001,合肥市,安徽省立医院麻醉科  
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中文摘要:
      
目的 探讨经食管超声多普勒在经尿道前列腺电切术(transurethral resection prostate, TURP)在治疗前列腺增生中的应用价值。
方法 选择行TURP患者36例,年龄60～85岁,ASA Ⅰ或Ⅱ级,前列腺增生≥Ⅲ度。患者入室后行动静脉穿侧,连续监测CVP,予以喉罩全麻,经鼻咽通气道置入经食管超声多普勒,监测校正血流时间(FTc)、每搏量(SV)和峰流速变量(ΔPV)。行TURP,术毕清醒后拔除喉罩。记录诱导前(T0)、诱导后20 min(T1)、冲洗量5 000 ml(T2)、冲洗量10 000 ml(T3)、冲洗量15 000 ml(T4)、冲洗量20 000 ml(T5) 时患者的CVP、Narcotrend值(NI)、血清Na+、K+浓度、Hb以及T1～T5时的FTc、SV和ΔPV。记录前列腺电切综合征(transurethral resection syndrome, TURS的发生情况。
结果 患者各时点CVP差异无统计学意义。与T1时比较,T3～T5时FTc、SV明显升高(P<0.05),T2～T5时ΔPV明显降低(P<0.05)。直线相关分析显示,FTc与CVP呈正相关(r=0.702,P<0.01),SV与CVP呈正相关(r=0.595,P<0.01),ΔPV与CVP呈负相关(r=-0.351,P<0.05),FTc与Na+浓度呈正相关(r=0.672,P<0.01)。无一例患者发生TURS。
结论 经食管超声多普勒可在TURP中连续动态实时监测,其主要指标FTc与CVP变化一致,且敏感度高于CVP;其结合动脉血气分析,有助于早期诊治TURS。
英文摘要:
      
Objective To explore the value of transesophageal doppler in transurethral resection prostate.
Methods Thirty-six patients (aged 60-85 years, falling into ASA grade Ⅰ-Ⅲ) of benign prostatic hyperplasia for undergoing transurethral resection prostate were enrolled. Through multifunction monitor, CVP, Narcotrend index(NI) were monitored before anesthesia induction (T0), 20 minutes after anesthesia induction (T1), after irrigating fluid of 5 000 ml (T2) and 10 000 ml (T3) and 15 000 ml (T4) and 20 000 ml (T5). By transesophageal doppler, FTc(corrected flowtime), SV(stroke volume), ΔPV(peak flow vaviable quantity) were monitored at T1-T5.
Results CVP at T1-T5 were not significantly changed compared with that at T0. Compared with T1, FTc, SV at T3-T5were significantly increased and ΔPV at T2-T5 were significantly decreased (P<0.05). CVP levels correlated significantly with both FTc (r=0.702, P<0.01) and SV (r=0.595, P<0.01). CVP negatively correlated significantly with ΔPV (r=-0.351, P<0.05). Furthermore, FTc correlated significantly with the concentrationof Na+(r=0.672,P<0.01). No patient had serum sodium ion concentration less than 125 mmol/L.
Conclusion FTc of transesophageal doppler is as accurate as central venous pressure in monitoring hemodynamic changes, and even more sensitive than CVP. It is useful in early diagnosis and treatment of TURS.
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