Евалуација на eлектролитниот, ацидо-базниот и коагулациониот статус при трансуретрална ресекција на простата

Abstract

Introduction: TURP is endoscopic urologic intervention, historical gold standard and the cornerstone for the treatment of BPH, but still related to intra- and postoperative adverse events, TURP syndrome, coagulopathy and bleeding. TURP syndrome is defined as the serum sodium concentration ≤ 125 mmol / L in combination with cardiovascular and neurological clinical manifestations. Based on this definition, the rate of TURP syndrome is between 0.5% and 10.5%. Serious changes in acid-base status and clinically relevant metabolic acidosis occurs in a greater amount of irrigation sy absorption during TURP. Primary fibrinolysis SEC cause coagulopathy and bleeding in TURP usually when resection is longer than 60 minutes. Materials and Methods: the approval of the ethics committee of the Medical Faculty, received the consent of 80 patients provided for TURP the Clinic for Urology. It's about a prospective clinical study that included patients with ASA 1-3 classification. Respondents were divided into 2 groups of 40 patients. Group 1 (n = 40), where the duration of TURP procedure was shorter than 60 minutes. and group 2 where the procedure was longer than 60 minutes. At all determining demographic characteristics, duration of the surgical procedure, physiological parameters, labolatoriski parameters (electrolyte, acid-base status and hematologic parameters), the occurrence of cardiovascular and neurological manifestations of TURP syndrome, the correlation between the value of serum sodium and manifestations of TURP syndrome is determined recessed weight of prostatic tissue volume of the used liquid and irrigation sy kolichevstvoto of i.v. administered infusion solutions. All procedures were performed under spinal anesthesia, and as irrigation sy fluid used sterile water. Results: Respondents duration of TURP intervention, shorter and longer than 60 minutes. insignificant differed in terms of average age, weight and height. The duration of surgery was significantly influenced by the values of MAP (p = 0,0011) and SpO2 (p = 0,00012). In terms of HR (p = 0.26) and RR (p = 0.73) had insignificant differences between the two groups of respondents. The length of surgery was significantly influenced by the electrolyte, acid-base and coagulation status. In the group where participants intervention lasted longer than 60 minutes, average values of sodium (139,45 ± 2,4vs132,22 ± 5,9vs130,02 ± 5,6) and chlorine (98,52 ± 2,1vs96,7 ± 3 9; p = 0.011) and intraoperative three hours postoperatively were significantly lower in the group with duration of intervention for more than 60 minutes, while the length of the intervention had no significant impact on the values of potassium (p = 0,15; p = 0,06 ). At the same time, reduced sodium values were correlated with the onset of clinical manifestations of TURP syndrome in the group of patients with surgery longer than 60 minutes. This study demonstrated coagulopathy and existence of primary fibrinolysis by reducing the values of Hb (p <0.001), PLT (p = 0.0015) and fibrinogen (p = 0.001), and also increased the values of PT (p = 0.006), PTT (p <0.01), INR (p <0.001) and D-dimer (p <0.001) in the group of patients with longer duration of resection 1 hour. The presence of specific metabolic acidosis TURP reduced in pH values (0.018, p = 0,000003), bicarbonates (p> 0.05, p = 0.002) and (p = 0,32, p = 0,008) there is a second group in respondents length TURP procedure more than 60 minutes. Significantly greater weight of resected prostatic tissue (p <0.01), more administration i.v. Infusion solutions (p <0.001) and greater volume of fluid used irrigation sy (p <0.001) exists in the second group of subjects with a longer surgical 1 hour. Conclusions: The duration of TURP procedure is the dominant risk factor for the electrolyte, and acid-base disturbances in coagulation status. Changes in serum sodium konentracija intra- and postoperative predict the development of clinical manifestations of TURP syndrome. The need for monitoring of electrolytes, acid-base status and coagulation during TURP should be individualized, taking into account the severity of prostatic tissue, the volume of fluid used irrigation sy, and the length of the surgical procedure. This study could expand the recommendations for better knowledge about the disorders and complications with TURP and possibly revision of previous experiences and knowledge with the changes observed in this study.