경요도 전립선 절제술시 투여한 Furosemide가 수술중, 후 혈중 나트륨 및 삼투질농도에 미치는 영향

Effects of Furosemide on perioperative Serum Osmolality and Electrolytes during Transurethral Resection of the Prostate

경뇨도 전립선 절제술을 시행한 환자 30명을 대상으로 하여 furosemide부여에 따른 혈중 나트륨치와 삼투질 농도를 비교 관찰한 결과 다음과 같은 결론을 얻었다. 1. 혈중 나트륨치는 대조군에서 술전에 비해 10분, 20분, 30분, 수술직후에 의의있는 감소(p<0.05)가 있었으나 실험군에서는 변화가 없었다. 2. 혈장 삼투질농도와 유효 삼투질농도는 대조군에서 술전치와 비교시 술중 30분과 수술직후에 의의있는 감소(p<0.05)가 있었으나 실험군에서는 잘 유지가 되었다. 이상의 결과로 보아 술중 흡수된 관류액의 영향을 줄일 목적으로 furosemide를 투여한 실험군에서 대조군에 비해 혈중나트륨치와 삼투질농도를 잘 유지시키기에 그 예방적 투여가 의의있다고 사료되며 특히 울혈성 심부전이나 신부전이 있는 환자의 수술시 furosemide를 투여하면 그 의의가 더 클 것으로 사료된다.

The purpose of this study was to prevent the dilutional effect of excessive absorption of irrigating solution by using furosemide intraoperatively during transurethral resection of the prostate, 30 patients, who belonged to physical status II or III of ASA classification, were selected randomly and divided with two groups as follows : G1(N=15) : Not-administrated furosemide(control group) G2(N=15) : Administrated furosemide(Experimental group). All patients were premedicated with Hydroxyzine(1mg/kg, IM) and were performed continous epidural anesthesia with 2% lidocaine(1-1.5mg/segment). For irrigating solution, 5% D-sorbitol was used and Hartman's solution were given for maintenance fluid and fixed the height of irrigating container to 60 cm from symphysis pubis. With the starting of operation, 20mg furosemide was administrated to experimental group. The blood samples for the values of $Na^+$, $K^+$, Glucose and BUN were performed at the periods of preoperation, 10 min, 20 min, 30 min after the starting of operation and immediate postoperation. Based these data, serum osmolality and effective osmolality were calculated. The results were as follows : 1. The sodium concentration of control group was decreased statistically significantly at 10 min, 20 min, 30 min after the starting of operation and immediate postoperative period as comparing with the preoperation value(p<0.05). But that of experimental Group was not changed significantly. 2. The serum osmolality and effective osmolality were decreased statistically significantly at 30 min after the starting of operation and immediate postoperative period as comparing with the preoperation value(p<0.05). But those of experimental group were not changed significantly. These results show that the dilutional effect of excessive absorption of irrigating solution might be prevented by using furosemide intraopertively. And so we recommend the use of furosemide during TURP, especially in patients with congestive heart failure or renal failure.