输尿管镜碎石术后重症感染的原因及防治

Causes and prevention of severe infection after ureteroscopic lithotripsy

目的探讨输尿管镜碎石术后重症感染的发生原因,寻找输尿管镜碎石术后重症感染的防治对策。方法选择2008年1月-2010年6月在医院行输尿管镜下气压弹道碎石术后并发重症感染者16例作为观察组,选择同期行输尿管镜下气压弹道碎石术未发生感染者20例进行对照,对两组患者年龄、性别、输尿管镜操作时间、术前感染情况、术中灌注压、术后引流情况进行比较。结果观察组输尿管镜操作时间(72±18)min、术中灌注压(81±7)mm Hg,对照组分别为(35±14)min(、65±6)mm Hg,观察组术前感染未控制、术后引流不畅发生率分别为93.8%、31.2%,对照组分别为10.0%、0,两组差异有统计学意义;而年龄、性别两组差异无统计学意义。结论输尿管镜操作时间长、术前感染未控制、术中灌注压力过高、术后引流不畅等是输尿管镜碎石术后并发重症感染的主要原因;术前有效抗感染治疗,提高碎石技巧及加强术后管理是预防感染的关键,治疗原则以抗感染和抗休克为主。

OBJECTIVE To explore the causes of severe infection after ureteroscopic lithotripsy,to find out the prevention and treatment measures.METHODS A total of 16 patients with severe infection who had underwent ureteroscopic lithotripsy were included in the study as the observation group,and meanwhile 20 cases without infection were adopted to the control group.Age,gender,ureteroscope operation time,preoperative infection,intraoperative perfusion pressure and postoperative drainage were compared between the two groups.RESULTS Ureteroscope operation time,preoperative infection,intraoperative perfusion pressure and postoperative drainage were significantly different between the two groups,but age and gender were without significant difference.CONCLUSIONS The causes of severe infection after ureteroscopic lithotripsy are long ureteroscope operation time,preoperative urinary tract infection,high perfusion pressure and postoperative urinary tract obstruction.Perioperative anti-infection,superb surgical skills and good postoperative management are important for preventing infection.Anti-infection and anti-shock are the keys for the treatment of severe infection after ureteroscopic lithotripsy.