经皮肾镜取石术后感染性休克的诊治体会

Diagnosis and Treatment of Septic Shock after Percutaneous Nephrolithotomy

【目的】探讨经皮肾镜气压弹道碎石术（PCNL）术后感染性休克的救治。【方法】分析361例PC—NL术后并发感染性休克11例患者的临床资料，总结诊治经验。【结果】术后并发感染性休克的发生率为3％。11例患者尿培养阳性，均为革兰阴性杆菌。7例发生严重肺部感染，3例出现呼吸衰竭并进行气管插管机械通气维持呼吸。结石成分分析：9例主要成分为碳酸磷灰石及磷酸镁铵，2例为草酸钙。11例患者均在3～5d后逐渐停用升压药物，生命体征稳定，术后3～8d后体温及血常规恢复正常。【结论]PCNL术后严重感染易致感染性休克，肺脏是最易受累的器官。推荐早期应用疗效确切的抗生素如美罗培南、亚胺培南。

[Objective] To explore the diagnosis and treatment of septic shock after percutaneous nephrolithotomy（PCNL）. [Methods] Clinical data of 11 cases with septic shock of 361 patients undergoing PCNL were analyzed. The experience in the diagnosis and treatment were summarized. [Results]The incidence rate of septic shock after PCNL was 3%. The urine culture was positive in 11 cases with gram negative bacteria. The severe lung infection occurred in 7 cases in which 3 cases with respiratory failure due to pulmonary infec tion were given endotraeheal intubation-meehanical ventilation （ETI-MV） to maintain respiration. The component of the calculi was magnesium ammonium phosphate and carbonate apatite in 9 cases and calcium oxalate in 2 cases. All the 11 cases had the withdrawal of vasopressors gradually and the vital signs were stable within 3 to 5 days. The body temperature and blood routine tests returned to normal 3~8 days later. [Conclusion] Se rious infection after PCNL is easy to induce septic shock. The lung is the most easily affected organ. Efficacious antibiotics such as meropenem or imipenem is recommended for the early treatment.