经皮肾镜碎石术后发热相关因素的研究进展

Research Progress of Factors Affecting Fever Following Percutaneous Nephrolithotomy

经皮肾镜碎石术(PCNL)已成为处理复杂上尿路结石最常用的手术方式之一。尽管术前可以预防性使用广谱抗菌素,但严重尿路感染、发热仍是PCNL术后常见并发症。虽然PCNL术后发热常能较快消退,在一些患者中仍可发生严重并发症。PCNL术后发热或者严重的尿路感染可增加患者死亡率、住院时间及医疗成本,因此,越来越多的医生开始关注可能导致PCNL术后发热的相关因素。本文主要综述了PCNL术后发热的可能机制及明确术前及术中可能导致PCNL术后发热的相关因素。根据近年国内外数据、文献可以得出,可能影响PCNL术后发热的因素包括糖尿病、术前肾造瘘管的使用、结石成分及形状、肾盂积脓、手术时间及灌注液量,术前尿路感染的适当治疗虽然不能阻止术后炎性反应或发热,但可以降低细菌感染率及促进从全身炎症反应综合征(SIRS)中的恢复。术前尿培养、结石细菌培养及肾盂尿培养均为术后发热的预测因子,能够为术后发热的抗菌素选择提供重要依据。

Percutaneous nephrolithotomy （PCNL） is one of the most popular methods of removing complicated upper urinary calculus. Despite of prophylactic use of wide-spectrum antibiotics, fever and serious bacteremia are still the most common complications. Although fever after PCNL usually resolves quickly, a more serious course can occur in some patients. Fever or serious urinary tract infections after PCNL increase mortality, hospital duration, and healthcare costs. As a result, more and more doctors begin to pay close attention to contributing factors to post-PCNL fever. This review mainly focuses on possible mechanism of fever following PCNL and identifying the preoperative and intra-operative factors that might affect development of fever following PCNL. According to recent foreign and domestic data, factors possibly affecting fever following percutaneous nephrolithotomy are diabetes, pre-operative use of a nephrostomy tube, operative time, stone composition and shape,purulent fluid in the pelvicaliceal system, operative time, perfusate quantity. Although appropriate treatment of preoperative urinary infections may not prevent fevor or a postoperative systemic response after PCNL but it seems to result in a decreased rate of bacteremia and possibly hastened recovery from systemic inflammatory response syndrome （SIRS）. Pre-operative urinary culture, stone and pelvic urine culture, providing an important foundation of antibiotic selection for the treatment of postoperative fever, are predictors of fever.