Clinical Study Of Pulmonary Ultrasound In Early Diagnosis Of Prostatectomy Syndrome

ObjectiveTo explore the role and significance of pulmonary ultrasound in the early diagnosis of Transurethral Resection Syndrome(TURS)in transurethral resection of the prostate(Transurethral Resection of the Prostate,TURP)in patients with benign prostatic hyperplasia(Benign Prostate Hyperplasia,BPH),so as to help anesthesiologists find TURS in time during the operation,so as to prevent the further aggravation of TURS,improve the safety of operation and improve the prognosis of patients.Methods1.Case selection:140 patients with BPH from June 2019 to August 2020 were selected to be included in this study.All patients were planned to undergo TURP,and the ASA grade range was grade Ⅰ-Ⅱ;Age 50-87 years old,body mass index(BＭI)18-24 kg/m2;Prostatic hyperplasia 2-3 degrees.2.Anesthesia methods:After entering the room,all patients were punctured to measure the pressure of radial artery,and were induced by dexamethasone,pentylethyl hydrochloride,midazolam,sufentanil,etomidate and cis atracurium.After induction,the laryngeal mask was placed and mechanical ventilation was performed to adjust the ventilator parameters:Vt 8 ml/kg,FiO2 60%,oxygen flow 2 L/min.Anesthesia was maintained by intravenous inhalation of propofol and remifentanil combined with sevoflurane,and cis atracurium 0.1 mg/kg was injected intravenously intermittently.In the lithotomy position,normal saline was used for irrigation during the operation,and the perfusion height was about 60-70 cm from the operation bed.3.Observation index:All patients were given pulmonary ultrasonography and arterial blood gas analysis,and the basic clinical indexes such as intraoperative fluid input and operation time were recorded.Observe and record before anesthesia(T0),when changing the lithotomy position after anesthesia(T1),when the volume of flushing fluid reaches 5000 ml(T2),when the volume of flushing fluid reaches 10000 ml(T3),when the volume of flushing fluid reaches 15000 ml(T4),when the volume of flushing fluid reaches 18000 ml(T5),when the volume of flushing fluid reaches 21000 ml(T6),when the volume of flushing fluid exceeds 21000 ml,record the heart rate(HR)and systolic pressure(SBP)at the end of the operation(T7),diastolic pressure(DBP)and peak airway pressure were equal to vital signs;Through arterial blood gas analysis,the levels of serum sodium ion(Na+),serum potassium ion(K+),hemoglobin(HB)and arterial partial pressure of oxygen(PaO2)were recorded at T0-T7.At the same time,the number of B-lines in the lungs of patients at T0-T7 was observed and recorded by ultrasonography,the lung ultrasonic B-line score(LUBS)was calculated,and the inferior vena cava collapse index(IVC-CI)and peak velocity variables were observed and recorded.4.Grouping:According to the conclusions of previous studies,in this study,the patients were divided into groups according to whether the serum Na+ was less than 130 mmol/L during the operation.The patients with serum Na+≥130 mmol/L were group A and those with serum Na+<130 mmol/L were group B.The vital signs,blood electrolyte indexes,arterial oxygen partial pressure,hemoglobin,lung B-line score,inferior vena cava collapse index and peak flow velocity variables were compared at different time points within and between groups.The correlation between lung B-line score and Na+,K+,Hb,airway peak pressure,intraoperative flushing volume,inferior vena cava collapse index and peak flow velocity was analyzed;The ROC curve was drawn to analyze the early diagnostic efficacy of pulmonary ultrasonography in TURS。5.Statistical methods:All the data in this study are analyzed and processed by SPSS22.0 software,and the counting data are expressed in the form of percentage[n(%)]and tested by x 2 test.All measurement data in accordance with normal distribution are uniformly expressed by mean ±standard deviation(x±s).The analysis of variance designed by repeated measurement data was used for intra-group comparison,and the independent sample T-test was used for inter-group comparison.Spearman correlation analysis software was used to analyze the correlation between pulmonary ultrasound results and Na+,K+concentration,Hb,peak airway pressure,flushing volume and so on.The receiver operating characteristic curve(ROC)was drawn to analyze the early diagnostic efficiency of pulmonary ultrasonography in TURS.The difference was statistically significant(P<0.05).Results:1.140 patients with BPH were treated with TURP,of which 31 cases had serum Na+<130 mmol/L.The study showed that TURS syndrome could be considered when serum Na+<125 mmol/L.In this study,a total of 6 patients had serum Na+<125 mmol/L,that is,6 patients were considered to have TURS.Among the 140 patients,TURS occurred in 6 cases,with an incidence of 4.29%.2.Compared with To at T1-T7 time point,HR and PaO2 in both groups decreased at T2-T7 time point compared with T1,and SBP and DBP in both groups decreased at T2-T7 time point compared with T0 and T3-T7 time point compared with T1,and the difference was statistically significant(P<0.05).The PaO2 of patients at T3-T7 time point and the same time point in group B was significantly lower than that in group A,and there was significant difference in SBP and DBP between groups at T7 time point(P<0.05).3.Comparison of Na+ with T0 and T1 at T3-T7 time point in two groups of patients.K+at T2-T7 time point compared with T0 and T1,and Hb at T3-T7 time point compared with T0 and T1,all of them showed a continuous downward trend,and the difference was statistically significant.In group A,the airway pressure at T7 was higher than that at T1.In group B,T6 and T7 were significantly higher than T1,and the difference was statistically significant(P<0.05).Compared with the results of the two groups,the Na+and K+of the two groups at the corresponding time point of T5-T7 in group B were lower than those in group A,and the difference was statistically significant(P<0.05).The peak airway pressure at T7 time point in group B was significantly higher than that in group A(P<0.05).4.The LUBS scores of the two groups continued to increase at T0-T7,and there were significant differences between T2-T7 and T0、T1(P<0.05).There was significant difference in the level of LUBS between groups at T5-T7 time point(P<0.05);5.The inferior vena cava collapse index in group B was lower than that in group A at T2-T4 time point,and the data difference was statistically significant(P<0.05).The peak flow rate variables of the two groups showed a downward trend at T0-T7 time points.Compared withTo at different time points,the data difference was statistically significant(P<0.05);6.Spearman correlation analysis showed that LUBS score in BPH patients was negatively correlated with Na+,K+,Hb,inferior vena cava collapse rate and peak flow velocity,and positively correlated with airway peak pressure and intraoperative flushing volume(P<0.05);7.The results of ROC curve showed that the results of lung ultrasound Lubs showed that the AUC area was 0.85,indicating that lung ultrasound has high diagnostic efficiency.Conclusion:In electroresection of prostate,pulmonary ultrasound can clearly show the B-line of each intercostal space,and the results are correlated with the changes of internal environment and the occurrence of TURS.According to the changing trend of pulmonary ultrasound results,we can predict and make the diagnosis of TURS in time.Pulmonary ultrasound plays an important role in the early diagnosis of TURS and is worth popularizing.