无创心排血量监测评估呋塞米预处理后经尿道等离子双极电切术对老年患者血流动力学的影响

目的 应用无创心排血量监测观察呋塞米预处理后经尿道等离子双极电切术 （plasmakinetic resection of the prostate,PKRP）对老年患者血流动力学的影响。方法 选取2020年10月至2021年11月陕西省森林工业职工医院择期行经尿道PKRP男性患者50例,年龄65~80岁,ASAⅠ~Ⅱ级,BMI 20~28 kg/m²,采用随机数字表法分为两组（n=25）：对照组（C组）和预处理组（P组）。C组手术过程中出现恶心、呕吐、烦躁、血压升高、心率降低等前列腺电切术综合征（transurethral resection syndrome, TURS）先兆时给予呋塞米20 mg进行处理,P组手术60 min时给予呋塞米20 mg预处理。记录术前（T₀）、麻醉后（T₁）、手术开始（T₂）、手术30 min（T₃）、手术60 min（T₄）、手术90 min（T₅）、手术结束（T₆）7个不同时间点平均动脉压（mean arterial pressure,MAP）、心率（heart rate,HR）、每搏输出量变异（stroke volume variation, SVV）及全身液体水平（total body water, TBW）等血流动力学指标。于T₀、T₃、T₄、T₅、T₆采集动脉血2 mL,记录动脉血Na⁺、K⁺、血红蛋白（hemoglobin, Hb）、红细胞比容（hematocrit, Hct）数值。记录术中手术时间、输血例数、总输液量、总灌洗量、用药次数及TURS发生率。结果 与C组比较,P组T_5-6时HR升高、TBW和MAP降低,T₆时SVV降低、Hb升高（P<0.05）。与T₀时比较,C组T_4-6时HR降低、MAP和TBW升高,T₁、T_4-6时SVV升高;P组T₄时HR降低、MAP升高,T₁、T_4-5时SVV升高,T_4-5时TBW升高（P<0.05）。两组患者组间及组内不同时间点血气指标Na⁺、K⁺、Hct和术中用药次数及TURS发生率比较差异无统计学意义（P>0.05）。结论 手术60 min时给予呋塞米预处理可维持经尿道PKRP老年患者术中血流动力学稳定。无创心排血量监测可有效评估呋塞米预处理对术中血流动力学变化的影响,为临床治疗提供参考。

Application of noninvasive cardiac output monitoring to evaluate the effect of furosemide pretreatment on hemodynamics in PKRP elderly patients

Objective To observe the effect of furosemide preconditioning on hemodynamics in elderly patients undergoing plasmakinetic resection of the prostate （PKRP） by noninvasive cardiac output monitoring.Methods From October 2020 to November 2021, 50 male patients, aged 65~80 years, ASAⅠ~Ⅱ, BMI 20~28 kg/m², who were selected to undergo transurethral PKRP in Shaanxi Sengong Hospital, were randomly divided into two groups （each group 25 cases）： control group （group C） and pretreatment group （group P）. Group C was given furosemide 20 mg for treatment when nausea and vomiting, irritability, increased blood pressure, decreased heart rate and other auras of transurethral resection syndrome （TURS） occurred during the operation, and group P was given furosemide 20 mg for pretreatment 60 minutes after the operation. Hemodynamic indicators such as mean arterial pressure （MAP）, heart rate （HR）, stroke volume variation （SVV） and total body water （TBW） were measured at different time points before operation （T₀）, after anesthesia （T₁）, beginning of operation （T₂）, 30 min of operation （T₃）, 60 min of operation （T₄）, 90 min of operation （T₅）, and end of operation （T₆）. 2 mL of arterial blood was collected at T₀,T₃, T₄, T₅ and T₆, and the Na⁺, K⁺, hemoglobin（Hb）, hematocrit（Hct）of arterial blood were recorded. The operation time, the number of blood transfusion cases, the total infusion volume, the total lavage volume, the times of medication and the incidence of TURS were recorded.Results Compared with group C, HR increased, TBW and MAP decreased in group P at T_5-6, SVV decreased and Hb increased at T₆ （P<0.05）; Compared with T₀, HR decreased, MAP and TBW increased at T_4-6, SVV increased at T₁ and T_4-6 in group C; HR decreased and MAP increased at T₄, SVV increased at T₁ and T_4-5, and TBW increased at T_4-5 in group P （P<0.05）. There was no significant difference between the two groups in blood gas indicators Na⁺, K⁺, Hct, the times of medication during operation and incidence of TURS at different time points （P>0.05）.Conclusion Furosemide preconditioning at 60 min of operation can maintain the stability of hemodynamics in elderly patients with transurethral PKRP. Noninvasive cardiac output monitoring can effectively evaluate the effect of the furosemide pretreatment on intraoperative hemodynamic changes, and provide reference for clinical treatment.