| Objective To study the effect of irrigating fluid absorption on the changes in blood chemistry during hysteroscopic surgery and the relationship between the transient hyperglycaemia and hyponatremia; evaluate the safety and feasibility of 5% dextrose as distenting medium; find out the factors associated with fluid loss and measures to prevent complications related to fluid absorption. Methods (1) We developed a ewe model for operative hysteroscopy. It is designed to resect partial ewe's endometrium in different fluid infusion pressures, using 5% dextrose in water as distending medium and observe the visual clarity of intrauterine anatomy and the effect of different infusion pressures on fluid absorption. (2) Sixty patients with benign uterine conditions who underwent hysteroscopic resection were enrolled in our study. 5% dextrose was used as irrigating fluid. A specific infusion pressure was preseted. Patient age, uterine enlargement, type of myoma, operating time, blood loss and irrigating fluid deficit were tested as variables. Serum sodium, potassium, chlorid, urea nitrogen, creatinine, glucose concentrations and plasm osmolality, anion gap, CO2-CP were measured before, at the end of, 1 hour, 3 hours after operation respectively. Results were analyzed by ANOV, Linear Regression analysis, and t-test. Results (1) Animal experiment has shown that the visual clarity was poor due to venous bleeding into the intrauterine cavity when infusion pressure was lower than 100mmHg. The mean fluid deficit was 140ml when the pressure was set at 100mmHg and 835 ml when the pressure was 150mmHg. (2) The mean(+/-SD) operating time was 40.2 + 14.86 (10-90) minutes and intraoperative blood loss was47.98+38.14 (10-150) ml. The mean volume of infused dextrose solution was 5422.87+1768.88 (2000-10000) ml, with a mean fluid deficit of 742.45 + 409.56 (100-2440) ml. In 48(80%) patients the fluid deficit was less than 1000 ml, and in 12(20%) patients it was equal to or higher than 1000 ml. (2) There was a significant fall in serum sodium, potassium, urea nitrogen concentrations and anion gap as well as plasm osmolality after operation(P < 0.05), and no apparent change were found in chlorid, CO2-CP and creatinine(P >0.05). The elevation of plasma glucose concentration was significant at the end of operation(P <0.05). It was 1 hour after surgery that the lowest serum sodium, urea nitrogen concentration, plasma osmolality, anion gap appeared, but the lowest serum potassium was at the end of operation. All changes in blood chemistry gradually restored 3 hours after surgery. (3) The fall in serum sodium concentration correlated positively with the fluid deficit (r =0.520, P < 0.01). The group with a fluid deficit exceeding 1000 ml had a significantly(P < 0.001) higher fall in serum sodium concentration. (4) Change in plasma glucose concentration was not apparent in the group with a fluid deficit less than 1000 ml, but correlated positively with the fluid deficit (r = 0.838, P = 0.001) in the group with a fluid deficit exceeding 1000 ml, as well as with the patients age(r = 0.262, P = 0.044). (5) With controlling the effect of fluid deficit, the fall in serum sodium concentration was not correlated with the elevation of plasma glucose(P > 0.05). (6) The change in serum potassium concentration correlated positively with the fluid deficit (r = 0.336, P = 0.008), but the fall in plasma osmolality and anion gap did with the fall in serum sodium (P < 0.01). (7) Fluid deficit was associated with the operating time and blood loss, type II fibroid patients retained a significantly (P < 0.001) higher volume of 5% dextrose solution than the group of patients who had a Type I or a type 0 fibroid resected. There was no difference among different type of operation. The use of the oxytocin and tubal patency did not have a major effect on fluid balance. Conclusions There were transient changes in serum sodium, potassium, ureanitrogen, plasma glucose concentrations and anion gap, as well as plasm osmolality due to the absorption of irrigating fluid durin...
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