体外冲击波碎石致尿脓毒症的临床分析

Treatment of urosepsis induced by extracorporeal shock wave lithotripsy:analysis of 4 cases

目的提高体外冲击波碎石（ESWL）术后并发尿脓毒症的临床认识及诊疗水平。方法对经ESWL后并发尿脓毒症的4例患者的临床资料进行回顾性分析。4例肾结石或输尿管结石患者在接受ESWL术后6-36 h内出现尿脓毒症的临床表现,尿细菌培养2例为大肠埃希菌感染,1例肺炎克雷伯杆菌,1例大肠埃希菌并恶臭假单胞菌。结果 4例患者经心电、血压及氧饱和度监测,吸氧、补液、抗炎、升压等治疗,分别在术后5-11 d（平均6.75 d）生命体征恢复平稳,3例行输尿管镜下气压弹道碎石,1例紧急行膀胱镜下DJ管置入引流肾盂液体,经保守治疗11 d后结石排出,4例病人均痊愈出院。结论 ESWL术前伴有泌尿系感染的患者更易发生尿脓毒症;临床发现尿脓毒症时需要及早诊断,积极治疗,以保守治疗为主。

Objective To evaluate the strategy for management of urosepsis after extracorporeal shock wave lithotripsy（ESWL）.Methods The clinical data were analyzed in 4 cases of urosepsis caused by ESWL during the period from January,2008 to October 2011.Results Two of the patients had kidney stones and two had ureteral stones.Analysis of urine bacterial culture revealed the presence of E.coli in 2 cases,Klebsiella pneumoniae in 1 case and Pseudomonas putida combined E.coli in 1 case.All the 4 patients were monitored for ECG,blood pressure and oxygen saturation,and received fluid replacement and anti-inflammatory therapy.The vital signs of the patients became stable after 5-11 days（mean 6.75 days）.Three patients underwent ureteroscopic lithotripsy,and 1 patient had emergency ureteral stent indwelling.All the 4 patients were cured and discharged.Conclusions ESWL is more likely to cause urosepsis in patients with ureteral stones and urinary infection,for which early nonsurgical interventions should be administered immediately after the diagnosis is established.