输尿管上段结石术后全身炎症反应综合征的高危因素及预防措施

The high risk factors and management strategy of postoperative systemicinflammatory response syndrome in patients with upper ureteral calculi

目的探讨可能导致输尿管上段结石患者术后全身炎症反应综合征(systermic inflammatory response syndrome,SIRS)发生的危险因素,并提出针对性的预防对策,为泌尿系统结石经皮肾镜碎石术后SIRS的防治提供参考。方法采用回顾性分析的方法,抽取杭州市第一人民医院大江东院区2015年11月至2018年11月接受经皮肾镜碎石术治疗的374例输尿管上段结石患者为研究对象,记录患者结石大小、手术时间、结石位置等,中段尿、肾盂尿培养与结石培养等,采用logistic回归分析导致患者术后SIRS发生的高危因素,并对应危险因素提出预防对策。结果374例患者中术后68例发生SIRS,发生率18.18%;经χ~2检验与logistic回归分析检验证实:女性、手术时间长、尿路感染、糖尿病、肾功能不全、结石培养阳性、中重度肾积水均可能是导致输尿管上段结石患者术后SIRS发生危险因素(OR=4.63、3.77、2.35、2.13、2.89、12.59、3.92,P均<0.05)。结论女性患者、手术时间长、尿路感染、糖尿病、肾功能不全、中重度肾积水、结石培养阳性均可能增加SIRS发生率,术前为患者做好评估,缩短手术时间,并给予患者针对性的预防措施,对减少SIRS的发生有指导意义。

Objective To idiscuss the risk factors for postoperative systemic inflammatory response syndrome(SIRS)in patients with upper ureteral calculi,and to propose the targeted preventive measures.Methods A retrospective analysis was performed on clinical data of 374patients with upper ureteral calculi who received percutaneous nephrolithotomy treatment in Hangzhou First People′s Hospital from November 2015to November 2018.The size and location of the stone,the surgical procedure duration,urine culture,pyeloneuria culture and stone culture of the patients were recorded.Multivariate logistic regression analysis was used to identify the high risk factors related to postoperative SIRS.Results 68out of 374patients developed postoperative SIRS with the overall incidence rate of 18.18%.The chi-square test and multiple logistic regression analysis showed that female patients,longer surgical procedure,urinary tract infection,diabetes,renal dysfunction,stone culture positive,moderate to severe hydronephrosis were potential risk factors for postoperative SIRS in patients with upper ureteral calculi(OR=4.63,3.77,2.35,2.13,2.89,12.59,3.92,P<0.05).Conclusions Female patients,longer surgical procedure,urinary tract infection,diabetes,renal dysfunction,stone culture positive,moderate to severe hydronephrosis are major risk factors for postoperative SIRS in patients with upper ureteral calculi.Therefore,preoperative assessment,shorter surgical procedure and targeted preventive measures should be implemented to reduce the occurrence of SIRS.