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題 名 | Fluid Load during Operative Hysteroscopy=手術性子宮鏡術時的灌注液體評估 |
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作 者 | 吳東璧; 劉啟舉; 王德予; | 書刊名 | 中華民國婦產科醫學會會刊雜誌 |
卷 期 | 37:4 1998.12[民87.12] |
頁 次 | 頁137-143 |
分類號 | 417.14 |
關鍵詞 | 手術性子宮鏡; 血鈉值; 血清濃度; 純水; 重力灌注系統; Operative hysteroscopy; Blood sodium; Osmolarity; Distilled water; Gravity infusion system; |
語 文 | 英文(English) |
中文摘要 | 目的:以二階段研究評估純水重力灌注系統在子宮鏡手術的可行性,並監視病人 可能的生理性變化。 方法:在第一階段(21病例),使用改良動脈導管測量最低需要的子宮擴張壓力和灌注高 度。手術中每間隔15分鐘,及術後4小時,8小時及24小時,抽血測量血鈉值和血清滲透 壓。根據第一階段的結果,在第二階段(34病例)進一步分析術後4小時血鈉值和手術時間 及灌注水量的關聯性。 結果:在第一階段,21個病例中20例均成功的使用子宮鏡完成手術,1例因病變的不完 全切除而持續有經血過多症狀。有一病例在驗血時發現有血球溶解現象,但病人無任何不適 症狀。擴張子宮的最低壓力平均為56.6毫米汞柱(52-60)。灌注所需的最低高度為92.1公 分(85-100)。血清滲透壓不論術中、術後均無明顯改變。血清鈉值隨時間下降,在術後4小 時達最低點,然後回升。在第二階段(34病例),我們發現血鈉值減少量和手術時間成正比, 但相關性低(Y=2.12660+0.03954X,r=0.38932)。同樣地,血鈉值減少量也和進水量成正比, 但相關性也低(Y=4.61377+0.00157X,r=0.25986)。 結論:我們相信嚴格計算灌注水的進出量,術後給予暫時性的限水甚至預防性地使用3% 氯化鈉輸液,一直到測知術後4小時的血鈉值,應可預防進水過多造成的嚴重合併症。 |
英文摘要 | Objective: We conducted a two-phase study to evaluate the feasibility of water gravity infusion operative hysteroscopy, and to investigate the physiologic change during and after the operation. Method: In phase I, 20/21 patients with submucosal myoma underwent successful resection with an operative hysteroscope. We checked the minimal amount of infusion pressure required with a modified arterial line and checked blood sodium and osmolarity changes every 15 minutes during surgery and 4, 8, and 24 hours after the operation. Based on the data from phase I, we studied the relationships between postoperative sodium change, fluid load, and operation time in phase II (43 cases). In phase II, 34 patients underwent transcervical myomectomy, and the relationships between decreased sodium level, operation time, and fluid load in these cases were analyzed. Results: One case had the picture of hemolysis but the patient did not have any discomfort. The osmolarity change was not significant in our group. The decreased blood sodium level correlated positively with the operation time and the nadir presented 4 hours post-operation. It showed the decreased sodium level correlated positively with the operation time, but there was no significant linear relationship (Y=2.12660+0.03954X, r =0.38932). No linear relationship between fluid load and decreased sodium level were also found (Y= 4.61377+ 0.00157X, r = 0,25986). Conclusion: Although our experience was limited, the results can could give us a guide to prevent and correct any possible untoward change early. We believe that strict monitoring of the fluid load, checking the post-operative sodium level 4 hours after surgery, and maintaining fluid restriction or even providing a preventive hypertonic saline infusion after surgery until data regarding the sodium level 4 hours post-operation are available can help us prevent and eliminate the grave complication of fluid overload. |
本系統中英文摘要資訊取自各篇刊載內容。