微创经皮肾镜取石术患者术后感染性休克的临床诊断及治疗

Clinical diagnosis and treatment of septic shock after minimally invasive percutaneous nephrolithotomy

目的探讨微创经皮肾镜取石术后并发感染性休克的临床诊断及治疗方法,使患者及早度过休克期。方法选择2008年1月-2013年1月收治的13例经皮肾镜取石术后并发感染性休克的患者临床资料进行回顾性分析;数据采用SPSS13.0统计处理。结果 13例微创经皮肾镜取石术后并发感染性休克患者经对症治疗后,10例患者生命体征逐渐平稳、尿量正常、精神好转,14-72h内逐渐停用升压药,体温正常3d、血常规及血、尿培养阴性后停用抗菌药物;患者住院17-26d,平均（22.8±2.2）d痊愈出院,3例患者放弃治疗自行出院,治疗总有效率为76.9%;血压、心率、血常规治疗前后比较差异有统计学意义（P〈0.05）。结论微创经皮肾镜取石术后一旦发现感染,尽早确诊和治疗,以最大程度减少患者的痛苦,提高治愈率。

OBJECTIVE To explore the measures for clinical diagnosis and treatment of postoperative septic shock in patients undergoing minimally invasive percutaneous nephrolithotomy so as to help the patients to get through the stroke stage in a short term.METHODS A total of 13patients with postoperative septic shock who underwent the minimally invasive percutaneous nephrolithotomy from Jan 2008to Jan 2013were recruited in the study,then the clinical data of the patients were retrospectively analyzed,and the statistical analysis was performed with the use of SPSS13.0software.RESULTS After the symptomatic treatment of the 13patients with postoperative septic shock,10patients were with the viral signs gradually returning to stable,the urine volume normal,the mental status improved;vasopressors were withdrawn within 14-72hours,and antibiotics were withdrawn when the body temperature remained normal for three days and the blood routine,blood,and urine cultures were negative.The hospitalization duration of the patients ranged from 17to 26day,with the average of（22.8±2.2）days,3patients gave up the treatment to discharge,and the total effective rate of treatment was 76.9%.The difference in the blood pressure,heart rate,or blood routines between before and after the treatment was significant（P〈0.05）.CONCLUSION Once the infections occur after the minimally invasive percutaneous nephrolithotomy,it is necessary to confirm and treat the infections in a timely manner so as to minimize the patients＇ suffering and improve the cure rate.