输尿管镜下钬激光碎石术后感染性休克原因分析及临床对策

Analysis of the Causes of Septic Shock after Ureteroscopic Holmium Laser Lithotripsy and Clinical Countermeasure

【目的】探讨输尿管镜下钬激光碎石术并发感染性休克的原因及防治措施。【方法】回顾性分析2006年1月至2010年4月行输尿管镜下钬激光碎石术后发生感染性休克的5例患者的临床资料。【结果】5例患者均表现为术后1～6h内出现高热，血压降至90／60mmHg以下，中段尿培养2例为阳性，血培养均为阳性。感染性休克原因依次为：术前尿路感染未能得到良好控制，术中输尿管灌注压力过高、损伤输尿管、手术时间过长及术后引流不畅等。经给予抗感染、抗休克等对症支持治疗后4例患者治愈出院。1例有冠心病史患者因出现多器官功能障碍综合征而于术后d2抢救无效死亡。【结论】充分认识输尿管镜下钬激光碎石术后发生感染性休克的原因，术前抗感染治疗，术中恰当的操作技巧，术后保持引流通畅，早期发现及积极合理治疗，对输尿管镜下钬激光碎石术后感染性休克的防治具有重要意义。

[Objective] To explore the causes and treatment of septic shock after ureteroscopic holmium la ser lithotripsy and their prevention and cure. [Methods] The clinical data of 5 patients with septic shock after ureteroscopic holmium laser lithotripsy between January 2006 and April 2010 were analyzed retrospectively. [Results] The manifestations of 5 patients were ardent fever and blood pressure below 90/60mmHg within 1- 6 hours after the operation. The mid stream urine culture was positive in 2 patients. The blood culture was positive in all patients. The causes of septic shock were uncontrolled preoperative urinary tract infection, peri- operative high perfusion pressure, intraoperative traumatic ureter, extended operation time and postoperative urinary tract obstruction by turns. All 5 patients underwent anti-shock and anti-infection therapies. After treatment, 4 patients were cured and discharged. One patient with the history of coronary artery disease died of multiple organ dysfunction syndrome at 2 days after operation. [Conclusion] For preventing septic shock af- ter ureteroscopic holmium laser lithotripsy, it is important to enough know the causes of septic shock after ure- teroscopic holmium laser lithotripsy, treat urinary tract infection preoperatively, possess appropriate operation skill intraoperatively, preserve the drainage of urinary tract postoperatively and depend on early diagnosis and proper treatment.