乙醇标记法定量预测灌注液吸收量在前列腺汽化切除手术中的安全性研究

发布时间：2019-07-09 13:57

【摘要】：目的:研究乙醇标记法监测在前列腺汽化术中的安全性和可行性,探讨呼出气乙醇浓度与灌注液吸收量之间的关系和术中进行灌注液吸收量监测的必要性。方法:随机选择两组各30例符合标准的前列腺增生患者,一组行前列腺等离子电切术,一组行1470半导体激光前列腺汽化切除术,在手术中使用含有1%浓度乙醇等渗盐水作为灌注液,在手术开始及整个手术过程中使用酒精检测仪每隔10分钟测定呼气末乙醇浓度,监测呼吸中乙醇浓度后根据Hahn公式将呼气乙醇浓度转换为血液乙醇浓度,评估手术中灌注液吸收量,在术前手术30分钟及手术结束时测定HB、HCT、血K+、NA+、CL+、PH及二氧化碳结合力,评估是否有液体吸收引起上述参数的改变。并且术中监测患者TURS发生情况和有无乙醇冲洗液吸收副反应发生。结果:60例前列腺增生手术患者术中接受乙醇浓度测定,术中监测未发现因带有乙醇的冲洗液吸收后出现副反应,未诱发过敏及心血管和肺部疾病发生,乙醇标记法监测在前列腺增生术中是安全可行的。通过乙醇浓度监测在前列腺等离子电切患者中有21例测出乙醇浓度,并根据根据Hahn公式将乙醇浓度转换后测出等离子电切中冲洗液吸收量约48.6-2650ml,术中2例患者出现了TURS予以及时纠正。而接受1470半导体激光手术患者中未监测到乙醇吸收。结论:乙醇标记法监测在临床中运用具有安全性和可行性,在冲洗液中加入一定浓度的乙醇,冲洗液通过吸收入血后通过循环在呼吸终末成功监测到了乙醇浓度,并通过Hahn公式我们可将其转换评估灌注液吸收量。1470nm半导体激光具有良好的组织消融和止血效果,术中灌注液吸收少,等离子电切相比较监测到一定量水吸收,但由于个体差异及患者综合因素,具体吸收量达到多少可以出现TURS还需要大量病例标本去研究。但前列腺增生病人中高危病人较多,心肺功能下降,我们将使用乙醇标记法定量监测术中可能存在灌洗液吸收,以期及早发现灌洗液的吸收量对心肺造成的不良影响,及时终止手术或积极治疗,可以有效降低病人围术期风险。
[Abstract]:Objective: to study the safety and feasibility of ethanol labeling in prostate vaporization, to explore the relationship between the concentration of ethanol exhaled and the absorption of perfusion fluid, and the necessity of monitoring the absorption of infusion fluid during operation. Methods: 30 patients with benign prostatic hyperplasia (BPH) in each group were randomly selected. One group underwent plasma resection of prostate and the other group underwent 1470 semiconductor laser vaporization of prostate. Saline containing 1% ethanol was used as perfusion solution during the operation. Alcohol detector was used to measure the concentration of ethanol every 10 minutes at the beginning of the operation and during the whole operation. After monitoring the concentration of ethanol in respiration, the concentration of ethanol in breath was converted into blood ethanol concentration according to Hahn formula, the absorption of perfusion fluid during operation was evaluated, the binding capacity of K, NA, CL, PH and carbon dioxide in HB,HCT, blood was measured 30 minutes before operation and at the end of operation, and the changes of the above parameters caused by liquid absorption were evaluated. The occurrence of TURS and the occurrence of side effects of ethanol flushing fluid absorption were monitored during operation. Results: the concentration of ethanol was measured during operation in 60 patients with benign prostatic hyperplasia (BPH). No side effects were found after the absorption of flushing fluid with ethanol, and no allergy and cardiovascular and pulmonary diseases were induced. Ethanol labeling was safe and feasible in benign prostatic hyperplasia (BPH). The ethanol concentration was measured in 21 patients with prostatectomy by ethanol concentration monitoring. According to Hahn formula, the absorption of flushing fluid in plasma electroresection was measured about 48.6 鈮，

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