逆行输尿管软镜钬激光碎石术后发生全身炎症反应综合征的危险因素分析

Analysis on risk factors of systemic inflammatory response syndrome after retrograde intrarenal surgery with holmium laser lithotripsy

目的：探讨逆行输尿管软镜钬激光碎石术（retrogradeintrarenalsurgery，RIRS）治疗肾结石术后发生全身炎症反鹰综合征（systemicinflammatoryresponsesyndrome，SIRS）的危险因素。方法：2013年间，我中心采用RIRS治疗肾结石患者493例，用单变量及多变量logistic回归分析患者术后发生SIRS的围手术期预测因素。结果：493例RIRS患者中，术后有30（6．1％）例发生sIRS；单变量logistic回归分析显示术后发生SIRs的危险因素分别为女性、尿白细胞阳性、尿培养为格兰阴性菌、手术时间、感染性结石、术后肾功能变化、术后血红蛋白下降〉10％（均P〈o．05）；多变量logistic回归逐步分析结果表明术前尿白细胞阳性（P=0．017，OR=3．50，95％CI=1．26～9．76）、尿培养为格兰阴性菌（P=0．018，OR=3．39，95％CI=1．23～9．33）、感染性结石（P=0．039，OR=2．86，95％CI=1．05～7．77）及术后肾功能恶化（P〈0．001，OR=14．51，95％CI=5．14～41．01）将增加RIRS术后发生SIRS的风险。结论：术前尿白细胞阳性、尿培养为格兰阴性菌、感染性结石及术后肾功能恶化是预测RIRS术后发生SIRS的独立危险因素。

Objective：To investigate the risk factors for systemic inflammatory response syndrome （SIRS） after retrograde intrarenal surgery （RIRS） with holmium laser lithotripsy in patients with renal stones. Method：Clinical data of 493 patients who underwent RIRS with holmium laser lithotripsy for upper urinary tract stones in 2013 were analyzed retrospectively. Univariate and multivariate logistic regression analysis were used to analyze periop- erative predictors after RIRS. Result： Thirty patients developed SIRS （6.1 %） after RIRS with holmium laser litho- tripsy. Univariate logistic regression analysis showed that risk factors for SIRS after RIRS with holmium laser lithotripsy were female, positive result of urine leukocyte, positive urine culture for gram-negative bacteria, oper- ating time, infectious stones, postoperative renal function changes and postoperative hemoglobulin decrease〉100% （P〈0.05）. Multivariate logistic regression analysis indicated that preoperative positive result of urine leukocyte （P=0. 017, OR=3.50, 95%CI=1.26-9.76）, positive urine culture for gram-negative bacteria （P=0. 018, OR 3.39, 95%CI=1.23-9.33）, infectious stones （P=0. 039, OR=2.86, 95%CI=1. 05-7. 77） and deterioration of renal function after operation （P〈0. 001, OR= 14.51, 95 %CI= 5.14-41.01） can increase the risk for SIRS af- ter RIRS. Conclusion：Preoperative positive result of urine leukocyte, positive urine culture for gram-negative bac- teria, infectious stones and deterioration of renal function after operation are independent risk factors to predict SIRS after RIRS with holmium laser lithotripsy.