输尿管软镜钬激光碎石术后并发尿脓毒血症的危险因素分析

Risk Factors of Urosepsis after Flexible Ureteroscopic Holmium Laser Lithotripsy

目的分析输尿管软镜钬激光碎石术后并发尿脓毒血症的危险因素。方法选取2019年在成都市新都区人民医院泌尿外科行输尿管软镜钬激光碎石术的252例患者作为研究对象,其中发生尿脓毒血症者29例作为观察组,其余223例未发生尿脓毒血症者作为对照组。比较两组患者临床特征,输尿管软镜钬激光碎石术后并发尿脓毒血症的危险因素分析采用二元Logistic回归分析。结果本研究输尿管软镜钬激光碎石术后尿脓毒血症发生率为11.5%(29/252)。观察组患者女性比例、糖尿病发生率及结石直径≥15 mm、手术时间≥60 min、术前尿培养结果阳性者所占比例高于对照组(P<0.05)。二元Logistic回归分析结果显示,女性〔OR=0.305,95%CI(0.127,0.733)〕、糖尿病〔OR=8.214,95%CI(2.553,26.428)〕、结石直径≥15 mm〔OR=0.382,95%CI(0.152,0.959)〕、手术时间≥60 min〔OR=4.560,95%CI(1.739,11.961)〕及术前尿培养结果阳性〔OR=3.389,95%CI(1.304,8.807)〕是输尿管软镜钬激光碎石术后并发尿脓毒血症的独立危险因素(P<0.05)。结论女性、糖尿病、结石直径≥15 mm、手术时间≥60 min及术前尿培养结果阳性可明显增加输尿管软镜钬激光碎石术后尿脓毒血症发生风险,应采用综合措施进行防治。

Objective To investigate the risk factors of urosepsis after flexible ureteroscopic holmium laser lithotripsy.Methods A total of 252 patients who underwent flexible ureteroscopic holmium laser lithotripsy were selected as the research subjects in 2019 in Department of Urology,Xindu District People’s Hospital,Chengdu,thereinto 29 cases complicated with urosepsis were served as observation group,the other 252 cases did not complicate with urosepsis were served as control group.Clinical features were compared between the two groups,and binary Logistic regression analysis was used to analyze the risk factors of urosepsis after flexible ureteroscopic holmium laser lithotripsy.Results Incidence of urosepsis after flexible ureteroscopic holmium laser lithotripsy was 11.5%(29/252)in this study.Female ratio,incidence of diabetes,proportion of patients with calculus diameter≥15 mm,duration of operation≥60 min,pre-operation positive urine culture result in observation group were statistically significantly higher than those in control group(P<0.05).Binary Logistic regression analysis results showed that,female〔OR=0.305,95%CI(0.127,0.733)〕,diabetes〔OR=8.214,95%CI(2.553,26.428)〕,calculus diameter≥15 mm〔OR=0.382,95%CI(0.152,0.959)〕,duration of operation≥60 min〔OR=4.560,95%CI(1.739,11.961)〕and pre-operation positive urine culture result〔OR=3.389,95%CI(1.304,8.807)〕were independent risk factors of urosepsis after flexible ureteroscopic holmium laser lithotripsy(P<0.05).Conclusion Female,diabetes,calculus diameter≥15 mm,duration of operation≥60 min and pre-operation positive urine culture result may increase the risk of urosepsis after flexible ureteroscopic holmium laser lithotripsy,which need comprehensive measures to prevent and treat.