术中应用利尿剂预防上尿路腔内碎石术后感染的临床研究

Infection-proventive effect of diuretic in procedure of endoscopic lithotripsy for upper urinary tract stones

目的:观察和探讨术中应用利尿剂预防上尿路结石腔内碎石术后感染的临床疗效。方法:自2003年11月～2006年4月,共160例上尿路结石患者入组,随机分为利尿剂应用组(n=81)和对照组(n=79),其中行经皮肾镜治疗者62例,行输尿管硬镜治疗者71例,输尿管软镜治疗者27例。利尿剂组于解除尿路梗阻后(经皮肾镜治疗为建立经皮肾通道后;输尿管硬镜治疗为击碎结石并引流肾盂尿后;输尿管软镜治疗为置入外鞘后),静脉推注速尿20mg;对照组术中不作特殊处理。术后两组均建立通畅的尿液引流,经皮肾镜治疗术后置双J管及肾造瘘管;输尿管硬、软镜术后置双J管,同时给予同级抗生素防治感染。分别比较各种腔内碎石术后,两组中发生全身炎症反应综合征(Systemic inflammatory reaction syndrome,SIRS)及脓毒败血症休克的情况。结果:利尿剂应用组和对照组术后SIRS的发生率分别为7.4(6例)和17.7(14例)。其中经皮肾镜治疗后,两组SIRS的发生率分别为6.3(2例)和16.7(5例);输尿管硬镜治疗后为8.3(3例)和20.0(7例);输尿管软镜治疗后为7.7(1例)和14.3(2例)。对照组中行经皮肾镜和输尿管硬镜碎石后,各有2例SIRS患者发展为脓毒败血症休克。结论:通过术中应用利尿剂,抑制肾小管重吸收,减少了术中灌洗致肾盂内高压而引起的细菌、细菌毒素反流和吸收,从而有效降低上尿路结石腔内碎石术后感染的发生率。

Objective：To explore the protective effect of diuretic on preventing infection during the procedure of endoscopic lithotripsy for the treatment of upper urinary stones. Methods： From November, 2003 to April, 2006, 160 patients was randomly divided into diuretic group （ n = 81） and control group （ n = 79）, treated respectively with three different procedures （PCNL, rigid, and flexible ureteroscopic lithotripsy）. During the procedure, 20 mg furosemide was intravenous injected after the urinary tract obstruction was resolved. Nephrostomy and D-J stent were respectively used after the operations.. And the inflammation situation was evaluated observing SIRS （systemic inflammatory reaction syndrome） and septic shock. Results： SIRS rate in diuretic and control group was 7.4% （6/81） and 17.7% （14/79）, with significant difference （ P〈0.05）. As for the different procedures, the SIRS rates in two groups were also observed to be dramatically different （ P〈0.05）. There were 2 patients involved with septic shock following PNL and rigid ureteroscopic lithotripsy respectively in control group, and all the patients with post--operation inflammation were cured in the end. Conclusions： Diuretics can play protective role in preventing the inflammation during endoscopic lithotripsy for upper urinary tract stones.