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

Abstract

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

CLC Number:

R693

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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References 26

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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

Application of dynamic monitoring index pulse pressure variability based on cardiopulmonary interaction in early prevention of prostate resection syndrome

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项目	组别	T1	T2	T3	T4
Hct/%	对照组	40.03 ± 3.24	39.64 ± 3.18	36.24 ± 4.22	34.67 ± 3.42
Hct/%	观察组	40.72 ± 3.31	40.02 ± 3.11	37.21 ± 3.35	35.14 ± 3.72
Hb/(g/L)	对照组	127.42 ± 11.38	121.35 ± 10.36	118.62 ± 9.57	109.36 ± 9.46
Hb/(g/L)	观察组	126.56 ± 11.67	120.58 ± 9.89	119.52 ± 9.12	110.24 ± 9.08

组别	低血压	高血压	心动过缓	气道压升高	P_ETCO₂	双肺湿啰音	苏醒延迟
对照组	4	2	5	2	1	1	1
观察组	2	1	4	1	0	0	0