TURPにおよるMannitol点滴静注法 --とくに著者が試作したMannitol溶液の試用効果を中心として--

Abstract

Use of irrigating fluids are necessary and im p ortant, for transurethral prostatic resection. However, occurrence of side effects due to mostly changes in the electrolytes of the body fluids and complications well-known as TUR-reaction are not uncommon. In an attempt to prevent the so-called TUR-reaction, the following two kinds of mannitol solution for intravenous use were administered before, during and after the procedure. solution-I (M-I) Mannitol 15 % Glucose 5 % NaC1 0. 45 % solution-II (M-II) Mannitol 5 % Glucose 5 % NaC1 0. 25 % Clinical effectiveness of the solutions was evaluated by studying 15 recent cases of prostatic hypertrophy given our mannitol solutions (the first series), and 10 control cases of the same condition in which the TUR-procedure was performed using glucose or Ringer's solution (the second series). In the both series, " urigal " was used as irrigating fluid, which was put at the height of 60 to 80 cm. from the mid-bladder level. In the first series, the 15 patients studied were at first given 1 00 ml. of M-I for 15 to 20 minutes prior to the TUR-procedure, followed by administration of 300 ml. of the same for over an hour during the surgical procedure. Then after the surgery, M-II was given intravenously at the rate of 200 ml. per hour until 7 a.m. of the following day, the total of the solution being to be from 1, 800 to 4, 000 ml. The amount of tissue resected varied fro m 4 to 46 gm. and the operating time was mostly limited to one hour. In both of ne seri e s, serum electrolytes (Na, K, Cl, Ca), BUN and hematocrit were examined just before, immediately after, and further 4-, 8-and 24-hours after the completion of the TUR procedure. Urinary output via catheter was also measured every hour during the first 4 hours then every 4 hours during the first 24 hours after the surgery. The results obtained were as follows : The urinary output measured at a n one hour interval during the first 4 hours varied from 130 to 400 ml. The total of 4-hour output, however, was almost equal to the amount of simultaneous 4 hour intake of the solution. The 15 patients of the first series showed an average 24-hour output of 3, 050 ml., which was only 230 ml less than the average intake of the solution during the same period. Contrariwisely, control patients (the second series) showed an average 24-hour output of 1, 010 ml., which was 2, 040 ml. less than that of the mannitol-treated patients. In the first series, serum sodiu m level decreased as much as 5.4 meq/L at the immediate postoperative period and returned gradually with in the following 24 hours. Serum potassium showed an increase immediately after the operation and recorded the maximum value of 5.1 meq/L at the 4 th hour after the resection, which was 0.6 meq/L higher than the average preoperative value. The increased value gradually returned to preoperative level within 24 hours. In the contro l series, however, the serum potassium though showing an increase in its value immediately after the operation, only exceeded the normal limit as much as 0.2 meq/L at the 4 th hour after the operation. Serum sodium values, remained within normal limits. Both of the serum chlor and calcium values demonstrated no remarkable changes in either the mannitol-treated or the control series. The most remarkable merit of the mann i t ol solutions was noted in the changes of BUN values. In the control series, the BUN values showed gradual rise starting immediately after the operation and reached as high as an average of 29.9 mg/dl at the 24 th hour, of which result suggesting a riskiness of the transurethral prostatic resection to the aged patients with impaired kidney function. In the mannitol-treated series, the BUN values were successfully controlled within the normal limits. There was no case of oliguria or renal shutd o wn in all cases of the both series . Blood pressure was more stable in the 15 mannitol-treated patients as compared to that of the 10 control patients. Conc l u sively, it is suggested that intravenous infusion of the mannitol solutions (M-I and M-II) administered in the manner described in this paper is a desirable way to promote excretion of toxic substance, to increase urinary output, to minimize potential urinary tract infection, and to obviate postoperative irrigations. However further studies on the use of mannitol in the transurethral surgery are still needed in order to obtain better results, espeically in stabilizing serum electrolytes .