宫腔镜电切术中灌洗液吸收对患者血生化指标的影响

目的了解宫腔镜手术中灌洗液的吸收对患者血生化指标的影响。方法选择宫腔镜电切术患者60例,以5%葡萄糖作为膨宫介质,于术前、术毕、术后1、3h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SPSS10.0统计软件进行分析。结果60例患者除1例液体吸收超过2000ml者出现轻微恶心外,无手术并发症的发生。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,血糖较术前明显升高(P<0.05)。其中血清钠、尿素氮、血浆渗透压、阴离子间隙于术后1h最低,而血糖的最高值及血钾最低值均出现在手术结束时,术后3h各项指标逐渐恢复正常。结论宫腔镜电切术中灌洗液的吸收可导致一过性血清钠、钾、尿素氮、血糖、血浆渗透压及阴离子间隙的改变,减少灌洗液的吸收,术中术后严密监测血生化指标的变化是宫腔镜手术成功与安全的关键。

Impact of irrigating fluid absorption on blood biochemical parameters during hysteroscopic surgery

Objective To study the influence of irrigating fluid absorption on the changes in blood bio-chemistry during hysteroscopic surgery. Methods Sixty patients with benign uterine conditions who had underwent hysteroscopic resection were enrolled in our study. The solution of 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 and, at the end of operation, later 1 hour, 3 hours after operation respectively. The obtained results were analyzed by ANOV, linear regression analysis, and t-test. Results There was a significant fall in serum sodium, potassium, urea nitrogen concentrations, anion gap and plasm osmolality after operation (P<0.05). No apparent change was found in chlorid, CO2-CP and creatinine(P>0.05). The elevation of plasma glucose concentration was significant at the end of operation (P<0.05). It was 1 hour after surgery that the lowest serum sodium, urea nitrogen concentration, plasma osmolality, anion gap appeared, but the lowest serum potassium was at the end of operation. All changes in blood bio-chemistry gradually restored 3 hours after surgery. Conclusion 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.Wherefore, the decreasing absorption of irrigating fluid and strictly monitoring blood bio-chemical indexes of intra- and post- operation are keys of successful and safe operation.