持续中心静脉压监测在早期诊断前列腺电切综合征的临床意义

目的 观察经尿道前列腺电切术(transurethral resection of prostate,TURP)中中心静脉压(CVP)的变化情况,结合各时间点的电解质,渗透压及不良事件发生情况,探讨CVP监测在前列腺电切综合征(transurethral resection of prostate syndrome,T...

The clinical significance of continuously central venous pressure monitor in the early diagnosis of transurethrni resection of prostate syndrome

Objective To observe the clinical value of continuous central venous pressure monitoring combined with the plasma electrolyte,osmotic pressure and adverse event at different examining times in early diagnosis of transurethral resection of prostate(TURP)syndrome.Methods Forty patients undergoing TURP were randomly divided into observation group and control group.As the control group,20 patients undergoing TURP without central venous pressure(CVP)monitoring.While CVP increased more than 5 cm H2O(1 cm H2O=0.098 kPa)or CVP more than 20 cm H2O,a rapid bolus of of lasix(a loop diuretics)40 mg was given intravenously.If the patient presented as agitation in the control group,a detection of serum sodium was done as soon as possible.While the results showed the serum Na+ was reduced,the same management was executed as in the observation group.Results Compared with pre-operation,the changes of serum sodium had the trend of declining in control groups,In observation group,the CVP had the tendency of ascent in the progress of operation,The CVP is more than 12 cm H2O or increased 5 cm H2O than that of preoperative in five patients,and run up to 20 cm H2O in one patient 90 min post-operation(perfusion fluid about 20 000 ml-25 000 ml),followed by a rapid intravenous injection of 10 mg-20 mg lasix(a loop diuretics),afterwards we found that CVP returned to the pre-operative level.All of the five patients whose CVP increased had a decreased serum sodium in different degrees.1 case of transurethral resection of prostate syndrome(TURS)occurred in control group,while none occurred in observation group.Conclusion The CVP had the tendency of ascent in the progress of TURP operation,CVP reflected the changes of blood volume re-back to heart.If the CVP increased 5 cm H2O or the total greater than 12 cm H2O,early changes in TURS was prevented effectively through diureticing at early stage.Continuous monitoring of CVP had certain clinical significance in early TURP diagnosis,as the changes in blood volume induced by absorption of rinse solution were earlier than the changes in serum sodium.