宫腔镜下子宫黏膜下肌瘤电切术致严重低钠血症原因及预防

目的 探讨宫腔镜下子宫黏膜下肌瘤电切术致严重低钠血症原因及预防措施.方法 回顾性分析宫腔镜下子宫黏膜下肌瘤电切术患者106例,其中3例发生严重低钠血症.分析其发生的原因并总结处理方法.结果 106例患者中术后严重低钠血症发生率为2.8％(3/106),患者于术后约1h出现恶心、呕吐,查血钠均低于110 mmol/L,膨宫液用量为8000～ 10000 ml,排出量为6300～7500 ml.3例患者均立即给予处理,1例患者静脉滴注乳酸钠林格注射液及0.9％氯化钠,并间断注射呋塞米后15h血钠逐渐恢复正常；2例患者静脉滴注3％氯化钠及15％氯化钾,并注射呋塞米后12h血钠恢复正常,症状消失.结论 避免严重低钠血症的发生一方面可通过术中及时监测膨宫压力、膨宫液体出入量、严格控制手术时间、使用0.9％氯化钠膨宫、预防性使用呋塞米等方式,另一方面术者要提高自己的手术技能,术前认真评估高危因素.

Reason and prevention of severe hyponatremia in hysteroscope treatment of submucous myoma

Objective To investigate the reason and prevention of severe hyponatremia in hysteroscope treatment of the submucous myoma.Method Retrospective study was done on 106 cases of submucous myoma,3 cases with severe hyponatremia after hysteroscope treatment.Results The rate of hyponatremia was 2.8％(3/106),patients appeared nausea and vomiting 1 hour after hysteroscope treatment,blood sodium was lower than 110 mmol/L,volume of distention liquid was 8000-10000 ml,the volume of discharge was 6300-7500 ml.Three patients were treated immediately,1 patient was given sodium lactate Ringer injection and 0.9％ sodium chloride by intravenous drip,and furosemide by discontinuous injection 15 hours later,the hyponatremia was recovery; 2 patients were given 3％ sodium chloride and 15％ potassium chloride by intravenous drip,and furosemide by injection,12 hours later,the hyponatremia were recovery.Conclusion The prevention of severe hyponatremia complication after hysteroscope treatment of the submucous myoma not only need operate carefully but also need take active preventive measures.