宫腔镜电切术中监测血糖、血钠对预防TURS的临床意义

目的研究宫腔镜术中膨宫液的吸收对患者血糖、血钠的影响及血糖的升高与低钠血症的相关性。方法选择40例子宫良性病变患者行宫腔镜电切术,以5%葡萄糖作为膨宫介质,于手术开始时、手术30、60min、术毕分别采静脉血测定血钠、血糖。结果血糖于手术30、60min与术前值比较均显著增高(P<0.05)。而且60min与30min比较血糖有明显上升(P<0.05)。血钠30min与术前比较无明显差异(P>0.05),但60min时与术前比较血钠有显著降低(P<0.05)。手术时间>60min者术后血清钠较术前明显下降(P<0.05),血糖于术毕明显升高(P<0.05);血钠的降低与血糖的升高之间有相关性(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钠、血糖的改变;缩短手术时间,控制宫腔压力,减少灌流液吸收是预防电切综合征发生的关键;观察血糖的改变是更快和简捷方法之一,有效防止电切综合征发生。

The Clinical Importance of Monitoring Blood Glucose and Sodium During Hysteroscopic Surgery

Objective To study the effect of irrigating fluid absorption on thechanges in blood glucose and sodium during hysteroscopic infusion surgery and the relationship between the transient hyperglycaemia and hyponatremia. Methods Patients with benign uterine conditions who underwent hysteroscopic resection were enrolled in our study. 5% dextrose was used as irrigating fluid. Serum sodium, glucose were measured before, 30, 60 min, at the end of operation respectively. Results The blood glucose level increased markedly during operation as compared with that before operation (P < 0.05). There was a significant higher blood glucose level at 60 min than that 30 min during operation (P < 0.05). Serum sodium was not significant changed at 30 min compared with that before operation (P > 0.05). There was a significant lower sodium level after operation than that before when operating time more than 60 min (P < 0.05). The fall in serum sodium concentration was correlated with the elevation of plasma glucose (P > 0.05). Conclusion There are transient changes in serum sodium, plasma glucose due to theabsorption of irrigating fluid during hysteroscopic resection. It's the key method to prevent TURP syndrome by controlling operating time, the pressure in the uterine cavity and the absorption of irrigating flow. Observation of blood glucose is the fast and simple method to prevent transurethral resection of syndrome effectively.