上尿路腔内碎石术后并发感染性休克的处理和预防

Management and Prevention of Septic Shock after Endoscopic Lithotripsy for Upper Urinary Tract Stones

目的:探讨上尿路腔内碎石术后并发感染性休克的原因和防治措施。方法:回顾性分析2005年1月～2008年3月上尿路腔内碎石术后6例感染性休克患者的临床资料:男4例,女2例,年龄38～61岁,平均47岁。其中经皮肾镜(PCNL)治疗者4例,经尿道输尿管镜治疗者2例,均表现为术后3～16 h内出现高热(体温>39.0℃),血压降至80/50 mmHg(1 mmHg=0.133 kPa)以下,心率>110次/min。根据临床表现均诊断为感染性休克。6例均给予抗休克和抗感染等治疗。结果:5例患者在10～52 h后逐渐停用升压药物,1周内体温和血常规恢复正常,最后治愈出院。1例因出现多脏器功能障碍综合征(MODS)而于术后第6天抢救无效死亡。结论:感染性休克是上尿路腔内碎石术后严重并发症之一,早期发现及合理处理是治疗成功的关键,加强预防措施可减少术后重症感染。

Objective： To explore the etiology, management and prevention of septic shock after endoscopic lithotripsy for upper urinary tract stones. Methods.. A clinical data was retrospective analyzed which collected 6 patients （4 men, 2 women ） of septic shock after endoscopic lithotripsy for upper urinary tract stones from January 2005 to March 2008. Their age ranged from 38 to 61 years with a mean of 47 years. 4 patients were treated with percutaneous nephrolithotomy （PCNL）, 2 patients were treated with rigid ureteroscopic lithotripsy. The patients were characterized by the temperature over 39℃ the blood pressure below 80/50 rmnHg and a heart rate over 110 BPM within 3-16 hours after the operation. The diagnose of all the patients were septic shock according to the clinical manifestation. All 6 patients underwent antshock and ant-infection therapies rapidly. Resulits： The hypertensors of 5 patients were gradually stopped within 10 52 hours, their temperature and blood routine tests returned to normal within 1 week. 5 patients were cured in the end. 1 patient was died of multiple organ dysfunction syndrome （MODS） after 6 days of operation. Conclusions; Septic shock is one of serious complications after endoscopic lithotripsy for upper urinary tract stones. The key to the successful treatment depend on early diagnosis and proper treatment. The improvement in the prevention can effectively prevent the postoperation severe infection.