宫腔镜灌流液对患者病理生理学影响的研究

目的研究宫腔镜手术中灌流液(膨宫液)的吸收对患者生化指标的影响及一过性血糖的升高与低钠血症的相关性,检验并揭示5%葡萄糖作为膨宫介质的安全性与可行性.方法选择60例子宫内膜良性病变患者行宫腔镜电切术,以5%葡萄糖作为膨宫介质,于术前、术毕、术后1 h、术后3 h分别采静脉血测定血清钠、氯、钾、CO2-CP、尿素氮、肌酐、血浆渗透压、阴离子间隙及血糖等指标,结果应用SPSS 10.0统计软件进行分析.结果术后血清钠、钾、血浆渗透压、阴离子间隙、尿素氮均较术前明显下降(P＜0.05),血糖于术毕明显升高(P＜0.05);控制灌流液吸收因素后,血钠的降低与血糖的升高之间无明显相关性(P＞0.05).结论宫腔镜电切术中灌流液的吸收可引起一过性血清钠、钾、尿素氮、血糖、血浆渗透压及阴离子间隙的改变;一过性高血糖不会加重低钠血症,使用5%葡萄糖作为灌流液安全可行.

Study of pathophysiology effect of hysteroscopic infusion systems on patients during hysteroscopic surgery

To study the effect of irrigating fluid absorption on the changes in blood chemistry during hysteroscopic surgery and the relationship between the transient hyperglycaemia and hyponatremia; evaluate the safety and feasibility of 5% dextrose as distenting medium. Sixty patients with benign uterine conditions who underwent hysteroscopic resection were enrolled in our study. 5% dextrose was used as irrigating fluid. Serum sodium, potassium, chlorid, urea nitrogen, creatinine, glucose concentrations and plasm osmolality, anion gap, CO2-CP were measured before, at the end of, 1 hour, 3 hours after operation respectively. Data was analyzed by ANOV, Linear Regression analysis, and t-test. There was a significant fall in serum sodium, potassium, urea nitrogen concentrations and anion gap as well as plasm osmolality after operation (P< 0.05). With controlling the effect of fluid deficit, the fall in serum sodium concentration was not correlated with the elevation of plasma glucose (P> 0.05). [Conclusions] There are transient changes in serum sodium, potassium, urea nitrogen, plasma glucose concentrations and anion gap, as well as plasm osmolality due to the absorption of irrigating fluid during hysteroscopic resection. Temporary elevation of blood glucose dose not aggravate hyponatremia.