不同体位对经尿道前列腺等离子双极电切术患者术中冲洗液吸收的影响

目的:观察头低足高截石体位(LP)对接受经尿道前列腺等离子双极电切术(PKRP)患者术中冲洗液吸收的影响。方法:80例BPH患者,择期在腰硬联合麻醉下行PKRP术,随机分为两组,每组40例:0°LP组,常规截石体位,手术床保持水平;-10°LP组,常规截石体位,手术床头低足高倾斜10°。采用含1%乙醇的生理盐水溶液作为术中冲洗液。手术开始即刻,以及随后每10 min应用数字乙醇检测仪对患者呼出气中乙醇浓度进行测试并记录。同时记录两组手术时间,手术期间静脉输注晶体及胶体液量和切除前列腺组织的重量。监测并记录患者的平均动脉血压(MAP)和心率(HR),比较两组患者手术开始前5 min,开始后30 min,手术结束时的MAP和HR。通过动脉血气分析,测定手术开始前、开始后1 h动脉血Na^+、K^+、Cl^-、Ca^2+浓度。结果:两组患者年龄、身高、体重、前列腺体积等无显著差异,术中各时间点MAP和HR亦无显著差异。与术前5 min相比,0°LP组患者手术开始后1 h测得K^+及Ca^2+浓度显著低于术前水平K^+:(3.49±0.33)mmol/L vs(3.64±0.29)mmol/L,P=0.002;Ca^2+:(1.13±0.04)mmol/L vs(1.16±003)mmol/L,P=0.001],Cl-浓度显著高于术前水平(108.7±2.3)mmol/L vs(106.9±2.2)mmol/L,P=0.006],而Na^+浓度无明显变化(139.4±1.6)mmol/L vs(139.7±1.5)mmol/L,P=0.231]。-10°LP组患者Ca^2+浓度低于术前(1.13±0.04)mmol/L vs(1.14±0.04)mmol/L,P=0.016],Na^+(140.0±2.0)mmol/L vs(140.3±1.8)mmol/L,P=0.156]、K+(3.47±0.34)mmol/L vs(3.49±0.36)mmol/L,P=0.506]及Cl^-(109.1±2.5)mmol/L vs(108.2±2.6)mmol/L,P=0.071]浓度均无明显变化。0°LP组有6例患者(15%),-10°LP组有4例(10%)患者术中冲洗液吸收量>1500 ml,两组比较无统计学差异。结论:头低足高倾斜10°截石位,显著减轻PKRP手术导致的K^+降低,Cl^-升高,但不影响其他电解质变化。

Effects of different intraoperative lithotomy positions on the absorption of irrigation fluid during bipolar plasmakinetic resection of the prostate

Objective:To investigate the effect of intraoperative lithotomy position(LP)with a head-down tilt(HDT)on the absorption of intraoperative irrigation fluid in patients undergoing bipolar plasmakinetic resection of the prostate(PKRP).Methods:Eighty BPH patients underwent PKRP,40 in a conventional 0-degree position(0°LP)and the other 40 in a-10-degree HDT position(-10°LP),with 0.9%saline containing 1%ethanol as intraoperative irrigation fluid.We determined the alcohol concentration in the exhaled breath of the patients with a digital alcohol detector at the start of the operation and every 10 minutes afterwards.Meanwhile we recorded the operation time,the volume of intraoperative intravenous crystalloid infusion and the weight of the resected prostatic tissue,monitored the mean arterial pressure(MAP)and heart rate(HR)at 5 minutes before surgery,30 minutes after the start of surgery and the end of surgery,and measured the concentrations of Na^+,K^+,Cl^-and Ca^2+with an arterial blood gas analyzer at 5 minutes before surgery and 1 hour after the start of surgery.Results:There were no statistically significant differences in age,height,body weight and prostate volume,or in intraoperative MAP and HR between the 0°LP and-10°LP groups.Compared with the baseline,at 1 hour after the start of PKRP,the patients in the 0°LP group showed significantly decreased concentrations of K+(3.64±0.29]vs3.49±0.22]mmol/L,P=0.002)and Ca^2+(1.16±0.03]vs1.13±0.04]mmol/L,P=0.001),increased concentration of Cl^-(106.9±2.2]vs108.7±2.3]mmol/L,P=0.006),but no significant difference in the concentration of Na^+(139.7±1.5]vs139.4±1.6]mmol/L,P=0.231),while those in the-10°LP group exhibited remarkably decreased concentration of Ca^2+(1.14±0.04]vs1.13±0.04]mmol/L,P=0.016)but no statistically significant differences in the concentrations of Na^+(140.3±1.8]vs140.0±2.0]mmol/L,P=0.156),K^+(3.49±0.36]vs3.47±0.34]mmol/L,P=0.506)and Cl^-(108.2±2.6]vs109.1±2.5]mmol/L,P=0.071).Over 1500 ml of intraoperative irrigation fluid absorption was observed in 6 cases(15%)in the 0°LP group as compared with 4 cases(10%)in the-10°LP group,with no significant difference between the two groups.Conclusion:Lithotomy position with a 10-degree head-down tilt can reduce PKRP-induced decrease in the concentration of K^+and increase in that of Cl^-without affecting the levels of the other electrolytes.