The Clinical Significance Of Continuous Central Venous Pressure Monitoring In The Early Diagnosis Of Turs

Objectives To observe the clinical value of continuous central venous pressure monitoring combined with the plasma electrolyte, osmotic pressure and adverse event at different examining times in early diagnosis of TURP syndrome.Materials and methods Forty patients undergoing TURP were randomly divided into observation group and control group. Epidural anesthesia acupuncture was performed at the L2³ inter-space . Then a epidural catheter was placed and 2% lidocaine was given epidurally to achieve adequate anesthetic level of T₁0. The rinse solution was 4% mannitol. As the control group,20 patients undergoing TURP without CVP monitoring, while the observation group with monitoring of CVP by right internal jugular vein approach. Hemodynamic parameters, electrolyte, plasma osmolality, Hb , and Hct were measured and recorded at the time of preoperative(T₁), 45 min (T2) and 90 min (T₃) in the intra-operative, and at the time of postoperative(T₄) respectively. Total volume of rinse solution,time of operation and the quantity of intravenous transfusion were also recorded.If CVP increased more than 5cmH20 or CVP was more than 20 cmH20, rapid iv 40 mg dose of lasix (a loop diuretics). If the patient displayed agitation in the control group, detect serum sodium as soon as possible . While the results showed the serum Na+ was reduced, the same management was executed as in the observation group.Results1. Haemodynamics There were little changes in blood pressure and HR beteen the two groups (P>0.05). But significant difference was observed at T₁ ,T2,T₃ and T₄ in the changes of SBP, DBP. In observation group, the CVP had the tendency of ascent in the progress of operation, and there was significant difference among T₁, T2 and T₃ in CVP (P<0.05),but no difference was observed between T₁ and T₄ (P>0.05).The CVP is more than 12cmH₂O or increased 5cmH₂O than that of preoperative in five patients, and run up to 20cmH₂O in one patient in 90 min after the operation ( perfusion fluid about 20000-25000 ml ) , rapid intravenous injected 10-20 mg lasix (a loop diuretics), then we found that CVP returned to the preoperative level. All of the five patients whose CVP increased had a decreased serum sodium in different degrees.2. The changes of electrolytes:Compared with preoperation , the changes of serum Sodium had the trend of declining in control groups, particularly at 90 min after operation and the end of operation (P<0.01). There was no difference at preoperation and postoperation in observation group(P>0.05). In the two groups ,there was significant difference between T₃ and T₄ (P<0.05,P<0.01).The serum sodium of the patients in observed group is obviously higher than that in control group at the end of operation. There was significant difference between T₁ and T₄ in the changes of kalium in groups (P<0.05), but no significant difference at T₁,T2,T₃ and T₄ between groups. Also, there was no significant difference at T₁ ,T2,T₃ and T₄ in the changes of Chlorine between groups(P>0.05).3. The changes of osmotic pressure : The changes of osmotic pressure had the tendency of declining in the progress of operation in two groups. The osmotic pressure of the patients in observed group is higher than that in control group at the end of operation. Compared with osmotic pressure in T₁, significant difference was observed at T₃ ,T₄ (P<0.05,<0.01).And in observed group, significant difference was observed at T₁ and T₃ (P<0.05), in counter the rest time points had no differences (P>0.05). Between the two groups, there was significant difference at T₄ in the changes of osmotic pressure (P<0.05) and the rest had no difference (P>0.05)4. The changes of Hct and Hb had the tendency of declining in the progress of operation and significant difference was observed at T₁,T2,T₃ andT₄ (P<0.05,<0.01).There was no significant difference between the two groups (P>0.05). 5. TURS 1 case of TURS occurred in control group, while noneoccurred in observation group.Conclusions1. The CVP had the tendency of ascent in the progress of TURP operation. But oppositely , osmotic pressure , Hct and Hb declined.2. CVP reflected the changes of blood volume re-back to heart. If the CVP increased 5cmH₂O or the total greater than 12 cmH₂O,early changes TURS was prevented effectively through diureticing at early stage.3. Continuous monitoring of CVP had certain clinical significance in early TURP diagnosis, as the changes in blood volume induced by absorption of rinse solution were earlier than the changes in serum Sodium.