经皮肾镜取石术后感染性休克的高危因素分析

The Analysis of High Risk Factors on Postoperative Septic Shock of Percutaneous Nephrolithotomy

目的探讨经皮肾镜取石术(PCNL)后感染性休克的高危因素。方法回顾性分析自2008年5月至2011年10月本中心进行的266例行PCNL患者的临床资料,所有病例术前均行中段尿细菌培养和常规抗生素预防治疗。通过卡方检验分析评估尿培养结果和使用抗生素天数对术后感染性休克的影响。结果 266例行PCNL的患者中,9例术后出现感染性休克(3.4%),中段尿培养阳性者106例(66.3%),术前使用抗生素进行预防性抗炎治疗大于3天者93例(35%)。尿培养阳性患者,革兰阴性菌感染87例(82%),革兰阳性菌15例(14.2%),混合菌群4例(3.8%)。卡方分析显示尿培养阳性和抗生素使用不足3天与感染性休克明显相关(P<0.05),比值比(OR)分别为5.041和6.959。结论中段尿培养阳性和术前使用抗生素不足3天是感染性休克的高危因素,尿路感染中革兰阴性菌是最主要致病菌群。经皮肾镜取石术术前进行中段尿细菌培养,根据药敏结果选用敏感抗生素预防治疗>3天,对预防术后感染性休克十分有必要。

Objective To study the high risk factors on septic shock after percutaneous nephrolithotomy (PCNL). Methods 266 cases, came from Minimally Invasive Urology Center in Shandong provincial hospital from May 2008 to October 2011, were entered in this retrospective study. All cases preoperatively took the middle urine bacteria cultures and the conventional antibiotic prophylaxis. The risk factors resulting into septic shock after PCNL were analyzed using chi-square test. Results 9 cases occurred postoperatie septic shock (3.4%), 79 cases were midstream urine culture positive (29.7%), preoperative antibiotic use for preventive anti-inflammatory treatment ≤3 days in 93 cases (35%). With positive urine culture, gram-negative bacteria infection in 58 cases (73.4%), gram-positive in 10 cases (12.7%), the mixed bacteria group in 11 cases (13.9%). The chi-square analysis showed that the urine culture positive and antibiotics prophylaxis treatment ≤3 days are significantly related with septic shock(P<0.05), the odds ratio (OR) were 5.041 and 6.959. Conclusions Urine culture positive before the operation and use of antibiotics for prophylaxis less than three days are the high risk factors of septic shock. In the urinary tract bacterias gram-negative bacterium is the main pathogenic bacteria flora. Midstream urine bacteria culture before percutaneous nephrolithotomy is necessary for choosing sensitive antibiotics.