经皮肾镜取石术后尿脓毒症休克2例报告并文献复习

Uroseptic shock via percutaneous nephrolithotomy:2 cases report and review of literature

目的 探讨行经皮肾镜取石术（PCNL）后尿脓毒症休克的防治。方法 报告该科2013年1-12月收治的64例肾结石患者，术前给予3 d抗感染治疗，并行大通道经皮肾镜气压弹道碎石术后其中2例患者出现尿脓毒症休克，结合文献对PCNL后出现尿脓毒症休克的防治进行复习。结果 1例患者术后20 min开始出现血压下降、心率加快、高热，经补液、扩容、抗感染等综合治疗后治愈出院；1例患者手术碎石120 min后突然出现寒战、心率加快、血压下降，立即终止手术后经抗休克、抗感染等治疗后治愈出院。结论 术前给予患者充分抗感染治疗，术中灌洗保持低压，术后密切监测生命体征和神志变化并加强抗感染治疗，可有效防治PCNL后尿脓毒症休克的发生。

Objective To explore the prevention and treatment of uroseptic shock by percutaneous nephrolithotomy （PCNL）. Methods Sixty-four patients with calculi in the kidneys received by this department and accepted anti-biotics therapy for three days. After an pneumatic lithotripsy of major channel via nephroscope was conducted and then two of them were in uroseptic shock. Reviewing combined with literature about uroseptic shock after PCNL. Results Twenty minutes after surgery one patient developed the symptoms such as uroseptic shock with blood pressure fall,rapid heart rate and hyperpyrexia,who was promptly treated with fluid replacement,dilatation and anti-infection,and eventually discharged after the above comprehensive therapy. Another suddenly had chills,rapid heart rate,drop of blood pressure after 120 min when finishing the lithotripsy. Immediately the operation was stopped instead of giving anti-shock and anti-infection. Conclusion The comprehensive therapeutic schedule of anti-infection treatment before operation ,keeping a low blood pressure with lavage during the operation ,a close monitoring of vital signs and consciousness change after the operation as well as strengthening anti-infection shall prevent effectively uroseptic shock after PCNL.