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胸腔镜全身麻醉期间多尿一例
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Abstract:
目的：引起麻醉医师们对麻醉期间多尿的不良反应的重视。方法：回顾一例于胸腔镜下右下肺切除术中出现多尿的患者的临床资料，并以“全身麻醉”、“胸腔镜”和“多尿”以及该例患者术中维持用麻醉药物为主题词(包括中英文)在Pubmed和中国期刊全文数据库(CNKI)进行10年内(2013.01~2024.01)文献检索，收集并分析检索到的在麻醉期间出现多尿的患者资料。结果：该例患者为59岁女性，因“反复头颈部疼痛2年余，加重1周”入院，最终诊断为“右肺下叶恶性肿瘤”，于全身麻醉下行胸腔镜下右下肺切除术。在麻醉后患者出现尿量增加，最后统计术中尿量达4700 ml。其手术时长为7 h，术中监测患者循环稳定，内环境稳定，故除常规术中补液外未予其他特殊处理，术后患者情况良好并于10日后出院。检索文献共收集到16篇全身麻醉后多尿的患者资料，他们术中尿量为8750~1980 ml。结论：麻醉期间麻醉医师较关注术中少尿的问题，多尿情况虽然少见，但仍应引起重视，警惕术中因多尿引起的容量负平衡而导致的循环不稳及内环境紊乱。
Objective: This paper aims to arouse anesthesiologists’ attention to the adverse reactions of polyuria during anesthesia. Methods: The clinical data of a patient with polyuria during thoracoscopic right lower lung resection were reviewed. In addition, a literature search of “general anesthesia”, “thoracoscopic”, “polyuria” and the intraoperative maintenance of anesthetic drugs in this case (both Chinese and English) was conducted in Pubmed and China Journal Full Text Database (CNKI) for 10 years (2013.01~2024.01), and the retrieved data of patients with polyuria during anesthesia were collected and analyzed. Results: The patient, a 59-year-old female, was admitted to hospital due to “recurrent head and neck pain for more than 2 years, aggravated for 1 week”. The final diagnosis was “malignant tumor of the lower lobe of the right lung” and thoracoscopic resection of the right lower lung was performed under general anesthesia. After anesthesia, the patient showed an increase in urine volume, and the final count of intraoperative urine volume was 4700 ml. The operation lasted for 7 h, the circulation of the patient was monitored during the operation, and the internal environment was stable, so no other special treatment was given except routine intraoperative fluid replenishment. The patient was in good condition after the operation and was discharged 10 days later. A total of 16 literatures on patients with polyuria after general anesthesia were collected, and their intraoperative urine volume was 8750~1980 ml. Conclusion: During anesthesia, anesthesiologists pay more attention to the problem of oliguria during the operation. Although polyuria is rare, it should still be paid attention to, and the circulation instability and internal environment disorder caused by negative volume balance caused by polyuria should be vigilant.
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