基于心肺交互作用的动态监测指标脉压变异率在早期预防前列腺电切综合征中的应用

doi:10.3969/j.issn.1006-5725.2025.06.005

摘要/Abstract

摘要：

目的通过观察经尿道前列腺电切术（TURP）中脉压变异率（PPV）的变化情况，探讨PPV在早期预防与诊断前列腺电切综合征中的临床意义。方法对2023年3—4月在全身麻醉下行TURP患者80例，随机分为对照组和观察组，每组40例。对照组行有创血压进行常规监测，观察组在行有创血压监测基础上持续监测PPV。观察并记录手术开始前（T1）、手术45 min时（T2）、手术90 min时（T3）及手术结束时（T4）四个时间点血流动力学指标、电解质Na^＋、K^＋、CL^-、血红蛋白（Hb）和红细胞压积（Hct）的变化情况，记录手术时间、术中灌洗液用量和稀释性低钠血症的（TURS）发生情况。结果观察组中有1例患者术中出现两次不明原因的血压和心率降低，结合血气分析确诊TURS。其中观察组患者PPV随手术时间延长呈现下降趋势，手术45 ~ 60 min时PPV逐渐降低，手术90 min时PPV较术前明显降低，其中有6例患者PPV较术前降低50%，对于以上PPV明显降低患者立即给予呋塞米10～20 mg、地塞米松10 mg，至手术结束时PPV基本恢复至术前水平。两组患者的Na⁺、K⁺、Hct、Hb均呈现不同程度的下降。结论 PPV能够反映患者的容量状况，当PPV较术前降低超过50%且术中出现无法解释的血流动力学改变以及异常临床表现时，需要提高警惕，及时处理可减少和预防TURS的发生。

关键词: 心肺交互作用, 动态监测, 脉压变异率, 前列腺电切综合征术

Abstract:

Objective To explore the clinical significance of pulse pressure variability （PPV） in early prevention and diagnosis of prostate resection syndrome by observing the changes in PPV during transurethral resection of the prostate. Methods Eighty patients undergoing transurethral resection of the prostate （TURP） under general anesthesia from March to April 2023 were randomly divided into a control group and an observation group， with 40 patients in each group. The control group underwent routine monitoring of invasive blood pressure， while the observation group continued to monitor PPV in addition to invasive blood pressure monitoring. Observe and record the hemodynamic parameters， electrolyte Na⁺， K⁺，CL ^-， Changes in hemoglobin （Hb） and hematocrit （Hct）， recording surgical time， intraoperative lavage fluid dosage， and occurrence of dilutive hyponatremia （TURS）. Results One patient in the observation group experienced two unexplained drops in blood pressure and heart rate during surgery， and was diagnosed with TURS based on blood gas analysis. Among them， the observation group showed a decreasing trend in PPV with the prolongation of surgery time. PPV gradually decreased at 45 ~ 60 minutes after surgery， and at 90 minutes after surgery， PPV decreased significantly compared to preoperative levels. Among them， 6 patients had a 50% decrease in PPV compared to preoperative levels. For patients with significantly reduced PPV， immediate treatment was given 10 ~ 20 mg of furosemide and 10 mg of dexamethasone. By the end of surgery， PPV had basically recovered to preoperative levels. Both groups of patients showed varying degrees of decrease in Na⁺， K⁺， Hct， and Hb levels. Conclusions PPV can reflect the volume status of patients. When PPV decreases by more than 50% compared to preoperative levels and there are unexplained hemodynamic changes and abnormal clinical manifestations during surgery， it is necessary to be vigilant and handle them promptly to reduce and prevent the occurrence of TURS.

Key words: cardiopulmonary interaction, dynamic monitoring, pulse pressure variability, TURP

中图分类号:

R693

付紫辉,蒋明,付群,张晓坤,杨荣,焦阳,史长喜. 基于心肺交互作用的动态监测指标脉压变异率在早期预防前列腺电切综合征中的应用[J]. 实用医学杂志, 2025, 41(6): 806-812.

Zihui FU,Ming JIANG,Qun FU,Xiaokun ZHANG,Rong YANG,Yang JIAO,Changxi. SHI. Application of dynamic monitoring index pulse pressure variability based on cardiopulmonary interaction in early prevention of prostate resection syndrome[J]. The Journal of Practical Medicine, 2025, 41(6): 806-812.

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项目	对照组	观察组	χ²/t值	P值
年龄/岁	45 ± 14	44 ± 16	0.333	0.740
体质量/kg	62.6 ± 10.5	63.5 ± 11.2	-0.415	0.679
身高/cm	167 ± 13	165 ± 12	0.799	0.426
BMI/(kg/m²）	22.3 ± 2.1	22.1 ± 2.3	0.454	0.651
基础SpO₂/%	97.6 ± 1.4	97.5 ± 1.5	0.345	0.731
ASA分级（Ⅰ/Ⅱ/Ⅲ，例）	6/35/9	7/33/10	0.188	0.910

组别	糖尿病	高血压	冠心病	COPD
对照组	2	11	5	2
观察组	3	10	6	1

项目	组别	T1	T2	T3	T4
SBP/mmHg	对照组	141.52 ± 18.20	137.24 ± 21.23	135.72 ± 20.21	134.35 ± 17.31
SBP/mmHg	观察组	142.47 ± 15.23	136.25 ± 24.25	135.62 ± 15.75	136.25 ± 13.35
DBP/mmHg	对照组	75.24 ± 9.82	72.32 ± 7.72	70.47 ± 11.23	69.52 ± 9.72
DBP/mmHg	观察组	79.27 ± 8.72	76.37 ± 8.51	71.57 ± 10.57	70.62 ± 8.28
HR/（次/min）	对照组	72.45 ± 11.21	71.62 ± 14.32	72.12 ± 11.62	68.65 ± 8.92
HR/（次/min）	观察组	71.45 ± 12.36	72.58 ± 11.31	71.85 ± 11.57	71.35 ± 12.53
SpO₂/%	对照组	97.32 ± 6.47	98.47 ± 5.23	97.58 ± 5.57	98.65 ± 7.54
SpO₂/%	观察组	96.45 ± 5.57	97.37 ± 4.57	97.08 ± 8.62	98.25 ± 6.65

项目	T1	T2	T3	T4
PPV/%	9.23 ± 1.82	7.65 ± 1.34	3.86 ± 1.78	8.71 ± 1.95
血钠/（mmol/L）	140.81 ± 6.52	140.23 ± 6.21	139.52 ± 5.72	140.16 ± 5.82

项目	组别	T1	T2	T3	T4
Na^＋/（mmol/L）	对照组	141.32 ± 6.51	140.12 ± 6.23	137.26 ± 6.62	134.35 ± 5.91
Na^＋/（mmol/L）	观察组	140.81 ± 6.52	140.23 ± 6.21	139.52 ± 5.72	140.16 ± 5.82
K^＋/（mmol/L）	对照组	4.15 ± 0.52	4.07 ± 0.47	3.98 ± 0.47	3.87 ± 0.42
K^＋/（mmol/L）	观察组	4.21 ± 0.64	4.11 ± 0.32	4.07 ± 0.57	3.86 ± 0.53
Cl^-/（mmol/L）	对照组	108.11 ± 4.32	106.85 ± 3.72	106.72 ± 3.21	106.16 ± 3.47
Cl^-/（mmol/L）	观察组	107.62 ± 3.72	106.12 ± 4.11	105.78 ± 3.66	105.18 ± 3.75