发布时间：2014-12-23 来源：人大经济论坛

探讨经尿道前列腺电切术致水中毒的防治_药学专业毕业论文范文 【摘要】 目的：研究良性前列腺增生（BPH）患者经尿道前列腺电切术（TURP）水中毒预防与治疗的有效方法。方法：分析204例TURP患者中水中毒6例的诊治情况。6例年龄69~82岁，平均77.3±2.6岁；前列腺体积60~100ml，平均75.5±15.4ml， 国际前列腺症状评分24~32分，平均29.3±2.3分，水中毒于手术开始35~75min，平均45.3±12.5min后出现。采取治疗措施：（1）20%甘露醇脱水利尿；（2）补充高渗透压钠；（3）纠正低血压与酸中毒；（4）腹腔或膀胱前间隙穿刺引流积液；（5）立即中止或暂停手术。结果：经治疗后6例生命体征均转为平稳，无严重并发症发生，术后1个月随访皆排尿畅。结论： TURP为患者减少创伤、降低住院费用、缩短住院时间、提高疗效提供了保证，早发现早治疗水中毒使TURP术更为安全可靠。 【关键词】 良性前列腺增生；经尿道前列腺汽化电切术；水中毒 The prevention and treatment of overhydration in TURP cases [Abstract] Objective: To study the prevention and treatment of overhydration in transurethral prostatic resection (TURP) patients. Methods: 6 cases of diagnosing and treating overhydration were analysed. The average age is (77.3±2.6) yrs (69~82yrs), the average volume of prostate was (75.5±15.4) ml (60~100ml), and the international prostatic symptom score was (29.3±2.3) (24~32). The water toxic symptoms began within (35~75min)average (45.3±12.5) min after operation, and the therapeutic measures having been used included: (1) 20% mannitol for anhydration and diuresis; (2)supplying hyperosmosis natrium; (3)correcting hypotension and acidosis; (4)puncturing and draining hydrops of abdominal cavity or prevesical space; (5)stopping or suspending operation immediately. Results: All patients' vital signs turned to stable after treatment, no more severe complications occurred, and the follow-up 1 month after operation showed urinating smoothly. Conclusions: As a golden standard of BPH surgical treatment, the application of TURP may decrease patients' injury, cut down the cost of hospitalization, shorten the length of stay and increase the therapeutic efficacy. If proper protective measures are taken and early diagnosis and early treatment are given for those overhydration patients, the TURP method will be safer and more reliable. [Key words] Benign prostatic hypertrophy; Transurethral prostatectomy; Overhydration 良性前列腺增生（BPH）患者采用经尿道前列腺电切或汽化电切术（transurethral prostatectomy，TURP）治疗。该术式优点为创伤微小、失血量少、住院时间短、住院费用低等。目前它已取代绝大多数开放手术，成为多数中等以上医院泌尿外科医师的首选治疗方案。但TURP式术中易出现水中毒，即电切过程中大量水分进入循环系统，导致稀释性低钠血症与心力衰竭。如预防与处理不当，可造成严重后果甚至死亡[1，2]。我院2005年12月~2006年12月对204例患者施行TURP手术，其中6例发生水中毒，经紧急处理后取得满意疗效。 1 临床资料 1．1 一般资料 收治良性前列腺增生202例，因各种原因采用经耻骨上经膀胱摘除手术3例，经尿道前列腺电切或汽化电切术199例；前列腺癌5例无癌肿根治手术适应证，但有严重排尿困难而选择TURP，接受TURP术204例。204例年龄55~84岁，平均76.3±5.5岁；术前均有显著排尿困难，国际前列腺症状评分15~32分，平均26.3±5.5分，因急性尿潴留而留置导尿管入院32例。术中出现水中毒症状6例（2.94%），年龄69~82岁，平均77.3±2.6岁，前列腺体积60~100 ml平均75.5±15.4 ml，IPSS24~32分，平均29.3±2.3分。水中毒临床表现：（1）打哈欠，血压下降，使用升压药效果不明显，血气分析示血红蛋白、血细胞压积较术前下降明显，与估计的手术出血量不相符，血钾、血钠低于正常；（2）患者全腹或下腹部明显隆起，20号针头穿刺隆起部位有大量液体溢出；（3）术中电切时前列腺包膜被切穿，或膀胱颈口切除较多使得膀胱颈与前列腺部分分离，或作膀胱穿刺经腹膜能推知手术灌洗液大量渗入膀胱周围或进入腹腔内。