Objective To investigate the influence of electrolyte and non-electrolyte perfusion medium on the biochemical indicators of patients in the continuous perfusion hysteroscopic surgery in order to clear the safety of uterine distention medium.Methods Clinical information of 200 patients admitted to our hospital from February 2008 to February 2012 who received continuous perfusion hysteroscopic surgery was analyzed retrospectively.The patients were divided into the perfusion medium saline group [100 mm Hg (1 mm Hg=0.133 kPa)+0.9％ saline group] and the perfusion medium 5％ glucose group (100 mm Hg+5％ glucose group) according to the distention medium,with 100 patients in each group.The serum sodium,serum chloride,serum potassium,serum glucose,blood osmotic pressure,CO2-CP,urea nitrogen,creatinine,anion gap and the other biochemical indicators before,at the end of 1 hour after and 3 hours after the surgery were monitored.The changes of biochemical indicators before and after the surgery were compared,and statistical methods were used to analyze the correlation between the absorbed amount of uterine distention medium and the changes of biochemical indicators.Results In the perfusion medium 5％ glucose group,the postoperative serum sodium,serum potassium,blood osmotic pressure,urea nitrogen and anion gap significantly reduced compared to those before the surgery,but the serum glucose significantly increased compared to that before the surgery (P ＜ 0.05).The serum sodium,urea nitrogen,blood osmotic pressure and anion gap reached the lowest levels I hour after the surgery while the highest value of serum glucose and the lowest value of serum potassium appeared at the end of the surgery,and all the indicators returned to normal 3 hours after the surgery.In the perfusion medium saline group,the postoperative serum sodium,serum potassium,blood osmotic pressure,urea nitrogen and anion gap significantly reduced compared to those before the surgery,but the serum glucose significantly increased compared to that before the surgery (P ＜ 0.05).The blood osmotic pressure reached the lowest level and the urine nitrogen reached the highest level at the end of the surgery,the serum glucose reached the highest level and the serum sodium and serum potassium reached the lowest levels 3 hours after the surgery,and the other indicators did not change significantly after the surgey.Conclusion The electrolyte medium perfusion hysteroscopic surgery is superior to the non-electrolyte medium in maintaining the stability of the body's blood biochemical indicators.After the hysteroscopic surgery,the serum glucose level significantly increased while the serum sodium level significantly decreased,which returned to normal 12 hours after the surgery.Close intraoperative and postoperative monitoring of blood biochemical changes is the key to success and security of hysteroscopic surgery.%目的 探讨电解质与非电解质灌流介质在连续灌流式宫腔电切术中对患者生化指标的影响,以明确膨宫介质的安全性.方法 回顾性分析广东省深圳市南山区妇幼保健院2008年2月～2012年2月收治的200例采用连续灌流式宫腔电切术患者的临床资料,根据采用膨宫介质不同分为两组,每组各100例,灌流介质生理盐水组[100 mm Hg(1 mm Hg=0.133 kPa)+0.9％生理盐水组],灌流介质5％葡萄糖组(100 mm Hg+5％葡萄组)；监测手术开始前、术毕、术后1h、术后3h血钠、血氯、血钾、血糖、血渗透压、二氧化碳结合力、尿素氮、肌酐及阴离子间隙等生化指标,比较手术前后患者生化指标的变化,并应用统计学方法分析膨宫介质的吸收量与生化指标变化的相关性.结果 灌流介质5％葡萄糖组术后血清钠、钾、血浆渗透压、阴离子间隙、尿素氮均较术前明显下降,血糖较术前明显升高(P＜0.05).其中血清钠、尿素氮、血浆渗透压、阴离子间隙于术后1h最低,而血糖的最高值及血钾最低值均出现在手术结束时,术后3h各项指标逐渐恢复正常.灌流介质生理盐水组血清钠、钾、血浆渗透压、阴离子间隙、尿素氮均较术前明显下降,血糖较术前明显升高(P＜0.05),其中血浆渗透压于术毕降至最低,血糖与术后3h升至最高,血清钠、血钾于术后3h降至最低,其他指标手术前后均无明显改变.结论 选择电解质介质灌流的宫腔镜手术,对维持机体血生化指标的稳定效果优于非电解质介质.宫腔镜手术后机体血糖水平明显升高,血钠水平明显降低,其变化均于术后12 h恢复正常.术中术后严密监测血生化指标的变化是宫腔镜手术成功与安全的关键.
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