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目的:评价4℃5%葡萄糖溶液用于宫腔镜手术时对液体吸收量、失血量以及热损伤的影响。方法:(1)随机将异常子宫出血81例经药物治疗无效而行宫腔镜下子宫内膜切除术的患者分为两组,分别采用4℃5%葡萄糖溶液(42例)及常温5%葡萄糖溶液(39例)作膨宫介质,膨宫压力100mmHg,膨宫液流速为200ml/min。记录膨宫液吸收量、失血量,手术前后的血钠浓度;(2)取28例新鲜的离体子宫,以相同条件进行电凝及电切,光学显微镜下观察热坏死带深度。结果:(1)冷膨宫液组液体吸收量、出血量分别为263.69±143.82ml、36.95±22.18ml;常温膨宫液组分别为419.74±271.86ml、51.15±29.23ml,两组差异有显著性(P<0.01,P<0.05)。冷膨宫液组及常温膨宫液组血钠改变值分别为2.98±2.59mmol/L与4.59±3.71mmol/L,两组亦有显著差异(P<0.05)。(2)冷膨宫液组电切、电凝时热损伤深度为0.138±0.040mm和0.254±0.074mm,明显低于常温膨宫液组的0.166±0.052mm和0.313±0.126mm,差异均有显著性(P<0.05)。结论:冷膨宫液可以明显减少液体的吸收,减少术中出血,对血钠影响小,并可减轻热损伤,提高手术的安全性。
OBJECTIVE: To evaluate the effects of 4% 5% dextrose solution on fluid absorption, blood loss and heat injury during hysteroscopic surgery. Methods: (1) 81 cases of abnormal uterine bleeding were randomly divided into two groups. The patients underwent hysteroscopic endometrial resection were treated with 4% 5% glucose solution (42 cases) and normal temperature 5% glucose Solution (39 cases) as the media for uterine expansion, uterine pressure 100mmHg, uterine fluid flow rate of 200ml / min. Record the amount of uterine fluid absorption, blood loss, blood sodium concentration before and after surgery; (2) Take 28 cases of fresh uterus, with the same conditions for electrocoagulation and electrocision, the optical microscope observation of necrotic zone depth. Results: (1) The amount of liquid absorption and blood loss in the group of cold distention uterine fluid were 263.69 ± 143.82ml and 36.95 ± 22.18ml, respectively. The room temperature swelled liquid group was 419.74 ± 271.86ml and 51.15 ± 29.23ml respectively, with significant difference between the two groups (P <0.01, P <0.05). The changes of serum sodium in cold-blooded uterine fluid group and normal-temperature uterine fluid group were 2.98 ± 2.59mmol / L and 4.59 ± 3.71mmol / L, respectively. There was also significant difference between the two groups (P <0.05). (2) The depth of thermal injury in cold-blooded uterine fluid group was 0.138 ± 0.040mm and 0.254 ± 0.074mm, which was significantly lower than 0.166 ± 0.052mm and 0.313 ± 0.126mm, respectively Significance (P <0.05). Conclusion: The cold-blooded uterine fluid can significantly reduce the absorption of liquid, reduce intraoperative bleeding, the impact of sodium is small, and can reduce thermal injury and improve the safety of surgery.