泌尿系结石腔镜碎石术后重症感染的诊治

The Experience of Septic Shock Treatment after Percutaneous Nephrolithotomy or Ureteroscopic Lithotripsy for Uropoiesis Stone

目的探讨经皮肾镜、输尿管镜碎石术后重症感染的发生原因并总结治疗经验。方法回顾性分析2004年9月～2012年3月11例泌尿系结石腔镜碎石术后重症感染的临床资料。年龄45～68岁，平均52岁。经皮肾镜3例，经输尿管镜8例。术后2～10h出现高热、烦燥不安，血压降至70—80／45～50mmHg，心率110～130次／min，诊断感染性休克，均予以抗感染及抗休克治疗，保持肾造瘘管及导尿管在位通畅。结果生命体征逐渐平稳，尿量恢复正常，均在术后12。48h开始逐渐停用升压药物，5d体温及血常规恢复正常。结论泌尿系结石腔镜碎石术后重症感染的发生多见于术前合并泌尿系梗阻、感染，术中灌注压过高，术后引流不畅及手术时间过长的患者，针对上述原因采取积极有效的措施可降低重症感染的发生几率，而治疗的关键在于对感染性休克的早期诊断和及时处理。

Objective To investigate the etiology and treatment of septic shock after percutaneous nephrolithotomy or ureteroscopic lithotripsy in uropoiesis stone patients. Methods Retrospective analysis was conducted on the clinical data of 11 cases of septic shock after percutaneous nephrolithotomy or ureteroscopic lithotripsy from September 2004 to March 2012. Patients＇ age ranged from 45 to 68 years （mean, 52 years）. Three patients were treated with percutaneous nephrolithotomy and 8 patients were treated with ureteroscopic lithotripsy. All patients had high temperature after nephrolithotomy; blood pressure dropped to 70 - 80/45 - 50 mm Hg; heart rate was 110 - 130 per minute. The diagnosis was postoperative septic shock according to clinical manifestation. All patients underwent anti-shock and anti-infection therapies, and renal ostomy tube and urethral catheter were kept unobstructed. Results The vital signs of all the patients recovered gradually, and the urine output returned to normal. The administration of pressor agent was withdrawn 12 to 48 h after the surgery. Patients＇ temperature and blood routine tests returned to normal 5 days later. Conclusions Severe infection after percutaneous nephrolithotomy or ureteroscopic lithotripsy usually occur in patients with preoperational urinary tract infection, high perfusion pressure, postoperative urinary tract obstruction and long-time Surgery. Effective measures can be taken to lower severe postoperative infection. The key to successful treatment is early diagnosis and proper treatment.