经尿道前列腺等离子电切术术后失血量的危险因素分析
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摘要
目的分析影响经尿道前列腺等离子电切术(PKRP)术后失血量的危险因素。方法 80例行PKRP治疗的BHP患者,根据术后出血量分为观察组(冲洗液中含血量>30 mg/h,n=26)与对照组(冲洗液中血含量≤30 ml/h,n=54),比较两组年龄、术前基础性疾病、BPH病程、术后出血诱发原因等资料,分析影响PKRP患者术后出血量的影响因素。结果观察组与对照组糖尿病史、高血压史、贫血史、手术时间、术前服用抗血小板药物、术中损伤包膜、术中气囊导管安置不当、术中止血不彻底、术后膀胱痉挛、前列腺窝感染、术后便秘、活动过度等情况比较差异有统计学意义(P <0. 05);糖尿病史、术前服用抗血小板药物、术中损伤包膜、术中止血不彻底、术后膀胱痉挛均是影响PKRP术后出血的危险因素。结论术前积极控制患者基础性疾病,及时停用抗血小板药物,术后合理应用止痛药物,提高医者手术技巧,是降低PKRP患者术后出血风险的有效措施。
Objective To analyze the risk factors affecting postoperative blood loss volume after transurethral plasmakinetic resection of prostate( PKRP).Methods Eighty BHP patients treated with PKRP in our hospital were divided into observation group( blood volume in flushing fluid >30 mg/h,n = 26) and control group( blood content in flushing fluid ≤ 30 ml/h,n = 54) according to the postoperative blood loss volume. The data of age,preoperative basic diseases,BPH course and induced causes of postoperative blood loss were compared between the two groups,and the influencing factors affecting postoperative blood loss volume in the patients were analyzed.Results Univariate analysis showed that there were significant differences in history of diabetes,history of hypertension,history of anemia,operative time,preoperative use of antiplatelet drugs,intraoperative capsule injury,improper placement of intraoperative balloon catheter,incomplete intraoperative hemostasis,postoperative bladder spasm,prostatic fossa infection,postoperative constipation and hyperactivity between the two groups( P < 0. 05).Logistic multivariate regression analysis suggested that history of diabetes,preoperative use of antiplatelet drugs,intraoperative capsule injury,incomplete intraoperative hemostasis and postoperative bladder spasm were risk factors for postoperative blood loss after PKRP.Conclusion Preoperative active control of underlying diseases,timely discontinuation of antiplatelet drugs,postoperative rational application of analgesics and improvement of surgical techniques of doctors are effective measures to reduce the risk of postoperative blood loss in patients with PKRP.
Objective To analyze the risk factors affecting postoperative blood loss volume after transurethral plasmakinetic resection of prostate( PKRP).Methods Eighty BHP patients treated with PKRP in our hospital were divided into observation group( blood volume in flushing fluid >30 mg/h,n = 26) and control group( blood content in flushing fluid ≤ 30 ml/h,n = 54) according to the postoperative blood loss volume. The data of age,preoperative basic diseases,BPH course and induced causes of postoperative blood loss were compared between the two groups,and the influencing factors affecting postoperative blood loss volume in the patients were analyzed.Results Univariate analysis showed that there were significant differences in history of diabetes,history of hypertension,history of anemia,operative time,preoperative use of antiplatelet drugs,intraoperative capsule injury,improper placement of intraoperative balloon catheter,incomplete intraoperative hemostasis,postoperative bladder spasm,prostatic fossa infection,postoperative constipation and hyperactivity between the two groups( P < 0. 05).Logistic multivariate regression analysis suggested that history of diabetes,preoperative use of antiplatelet drugs,intraoperative capsule injury,incomplete intraoperative hemostasis and postoperative bladder spasm were risk factors for postoperative blood loss after PKRP.Conclusion Preoperative active control of underlying diseases,timely discontinuation of antiplatelet drugs,postoperative rational application of analgesics and improvement of surgical techniques of doctors are effective measures to reduce the risk of postoperative blood loss in patients with PKRP.
引文
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[7]张福周,龙清志,李磊,等.钬激光电切术对老年高血压患者前列腺增生的疗效及安全性[J].现代生物医学进展,2016,16(2):282-284.
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[9]高钦宗,金征宇,王志伟,等.抗血小板治疗对经皮肾穿刺造瘘术术后出血风险的影响[J].中国介入影像与治疗学,2018,15(2):65-68.
[10]邱伟智,王佳音,黄金钟.血小板输注治疗对抗血小板药物脑出血患者围手术期出血的预防[J].中国神经精神疾病杂志,2017,43(5):261-265.
[11]谭书韬,吴斌.TURP术前非那雄胺应用时间对围术期出血的影响[J].实用药物与临床,2017,20(3):283-286.
[12]王宁华,苏元华,董锐,等.经尿道等离子双极电切术与开放式前列腺切除术对前列腺增生患者性功能的影响[J].中国性科学,2017,26(7):8-11.
[13]兰岭,张羽冠,王瑾,等.宫腔镜手术稀释性低钠血症防治的研究进展[J].中国医学科学院学报,2016,38(4):470-474.
[14]江敦勤.经尿道双极等离子前列腺剜除术治疗良性前列腺增生症效果观察[J].山东医药,2016,56(46):97-99.
[15]王花.临床护理路径干预对经尿道前列腺电切术患者生活质量及术后并发症的影响[J].现代中西医结合杂志,2016,25(30):3409-3410.
[2]郭亚雄,贺文彦.前列腺增生患者下尿路症状对勃起功能的影响分析[J].中国性科学,2017,26(7):14-17.
[3]曾杨军,胡万里,程龙,等.经尿道前列腺等离子双极电切术和电切术治疗良性前列腺增生对性功能影响的Meta分析[J].临床外科杂志,2016,24(5):386-389.
[4]彭伟,吴海霞,桂定文,等.评价经尿道前列腺双极等离子电切术与前列腺电切术治疗良性前列腺增生的临床效果及其安全性[J].中国性科学,2017,26(5):24-27.
[5]于惠翀,吉日嘎拉,余大海.前列腺等离子电切术后出血相关因素分析[J].中国中西医结合外科杂志,2016,22(5):492-494.
[6]郑汉雄,郑少波,夏昕晖,等.改良Nesbit方式经尿道前列腺电切术对前列腺增生合并糖尿病患者生活质量的影响[J].中国性科学,2016,25(9):14-17.
[7]张福周,龙清志,李磊,等.钬激光电切术对老年高血压患者前列腺增生的疗效及安全性[J].现代生物医学进展,2016,16(2):282-284.
[8]陈励碧.前列腺增生术后出血致纤溶的临床表现及术后疗效、并发症的远期随访观察[J].血栓与止血学,2016,22(6):657-660.
[9]高钦宗,金征宇,王志伟,等.抗血小板治疗对经皮肾穿刺造瘘术术后出血风险的影响[J].中国介入影像与治疗学,2018,15(2):65-68.
[10]邱伟智,王佳音,黄金钟.血小板输注治疗对抗血小板药物脑出血患者围手术期出血的预防[J].中国神经精神疾病杂志,2017,43(5):261-265.
[11]谭书韬,吴斌.TURP术前非那雄胺应用时间对围术期出血的影响[J].实用药物与临床,2017,20(3):283-286.
[12]王宁华,苏元华,董锐,等.经尿道等离子双极电切术与开放式前列腺切除术对前列腺增生患者性功能的影响[J].中国性科学,2017,26(7):8-11.
[13]兰岭,张羽冠,王瑾,等.宫腔镜手术稀释性低钠血症防治的研究进展[J].中国医学科学院学报,2016,38(4):470-474.
[14]江敦勤.经尿道双极等离子前列腺剜除术治疗良性前列腺增生症效果观察[J].山东医药,2016,56(46):97-99.
[15]王花.临床护理路径干预对经尿道前列腺电切术患者生活质量及术后并发症的影响[J].现代中西医结合杂志,2016,25(30):3409-3410.