经皮肾镜取石术后尿源性脓毒血症的危险因素分析

Analysis the risk factors of urosepsis after percutaneous nephrolithotomy

目的 探讨经皮肾镜取石术（PCNL）术后发生尿源性脓毒血症的危险因素. 方法 回顾性分析2013年1月至2014年1月204例行PCNL的肾结石或输尿管上段结石患者的临床资料.男140例,女64例.年龄29～75岁,平均49岁.术前尿培养阳性率为14.7％ （30/204）;血肌酐46～340 μmol/L,平均（87.9±33.9） μmol/L.结石直径1.0～7.0 cm,平均（2.3±0.8）cm,其中鹿角形结石51例.204例均行PCNL,其中采用标准通道84例,微通道120例.采用单因素分析和Logistic回归分析法分析PCNL术后发生尿源性脓毒血症的危险因素. 结果 本组204例手术时间23～219 min,平均（68.4±26.9） min.术后9例（4.4％）发生尿源性脓毒血症,男2例,女7例.年龄20～73岁,平均（52.6± 15.2）岁.术前尿培养阳性7例.血肌酐67～ 134 μmmol/L,（85.4±24.8） μmmol/L.结石直径1.8 ～ 3.5 cm,平均（2.5±0.6）cm,其中鹿角形结石5例.采用标准通道5例,微通道4例.手术时间47～219 min,平均（86±53） min.单因素分析结果显示女性、术前尿培养阳性、鹿角形结石及手术时间＞90 min与尿源性脓毒血症的发生有关（P均＜0.05）.多因素分析结果显示女性（OR=6.001,95％CI：1.190～ 30.276）、术前尿培养阳性（OR=19.647,95％CI：3.918～98.562）与尿源性脓毒血症的发生相关（P均＜0.05）. 结论 女性、术前尿培养阳性是PCNL术后发生尿源性脓毒血症的危险因素.

Objective To investige the risk factors of urosepsis after percutaneous nephrolithotomy （PCNL）.Methods We retrospectively analyzed 204 renal calculi or proximally ureter calcui patients,who underwent ultrasound-guided PCNL,from January 2013 to January 2014.Among them,there were 140 men and 64 women,whose mean age was 49 years （range from 29 to 75 years）.Eighty-four operations were performed via standard channel and 120 operations were performed via micro channels.Fifty one patients had staghorn stones.Before operation,the urine culture positive rate was 14.7％ （30/204）.The creatinine level ranged from 46 to 340 μmol/L [mean （87.9±33.9） μmol/L].Average stone diameter was （2.3±0.8） cm （range 1.0-7.0 cm）.Mean operative time was （68.4±26.9） min （range 23-219 min）.The chi-square test and a logistic regression model were used to identify key risk factors.Results The operation duration ranged from 23 to 219 min,mean （68.4±26.9） min.Of 204 patients,9 （4.4％） suffered septic shock,including 7 female patients and 2 male patients.Their mean age was （52.6± 15.2） years （20-73 years）.Five operations were performed via standard channels and four operations were performed via micro channels.Five patients had staghorn stones.Urine culture positive rate was 77.8％ （7/9）.The average stone diameter was （2.5±0.6） cm （range 1.8-3.5 cm）.Mean operative time was （86±53） min （range 47-219 min）.In univariate analysis,significant associations was observed between female gender （P =0.005）,positive urine culture （P＜0.01）,staghorn calculi （P =0.035）,operative duration＞90 min （P =0.042） and sepsis after PCNL.While in multivariate analysis,female gender （OR=6.001,95％CI=1.190-30.276,P=0.03） and positive urine culture pre-operation （OR=19.647,95％CI=3.918-98.562,P＜0.01） were identified as independent risk factors for post-MPCNL septic shock.Conclusions Female gender and positive urine culture before operation are the key risk factors of urosepsis after percutaneous nephrolithotomy.