经皮肾镜取石术围手术期全身炎症反应综合征的影响因素

Influence factors of systemic inflammatory response syndrome in perioperative percutaneous nephrolithotomy surgery

目的:比较上尿路结石患者术前尿培养及术中肾盂尿、结石培养结果,探讨围手术期全身炎症反应综合征(SIRS)的影响因素。方法:收集210例行经皮肾镜手术(PCNL)患者临床资料,术前均留取中段尿培养,术中留取肾盂尿,采用标准化Stamey法留取结石标本,分别行细菌培养,对术后发生SIRS者依据结石培养结果选择抗生素。根据术后是否发生SIRS分为A组和B组。结果:年龄、结石大小、手术时间、性别、体质量指数、结石取石成功率等在两组中无明显统计学差异。术前尿培养、肾盂尿培养及结石培养在A组的阳性率分别为66.7%、46.7%、44.4%,其中3例发生感染性休克,3种培养均为阳性;在B组中的阳性率分别为13.9%、6.1%、5.5%。结论:术前尿培养、术中肾盂尿培养及结石培养对术后SIRS的发生起到很好地预测作用,术中肾盂尿及结石培养对术后抗生素的选择提供依据。

Objective： To predict the impact factors for preoperative and intraoperative occurrence of systemic inflammatory response syndrome （SIRS） comparing the pre-surgery patients with urinary calculi, pelvis surgery urine culture and stone culture results were compared. Methods： Two hundred and ten patients underwent percutaneous nephrolithotomy surgery and preoperative urine culture specimens, intraoperative urine specimens from the renal pelvis, bacterial specimens stone specimens were studied using a standardized method. Stamey cultivation of postoperative SIRS culture results were based on calculus choice of antibiotics. Postoperative SIRS（A group） had 45 cases（21.4%） and SIRS（group B） 165 patients（78.5%） were divided according to the results. Results：Age, stone size, operation time, gender, body mass index, stone success rate were not significantly different in both groups;preoperative urine culture, renal pelvis urine culture and stones culture positive rate in group A were 66.7%, 46.7%, 44.4%, respectively;Positive rates in group B were 13.9%, 6.1%, 5.5%, respectively;three cases had septic shock and all cultures were positive. Conclusion：Preoperative urine culture, pelvis surgery urine culture and stone culture have a very good predictive function on postoperative SIRS and pelvis surgery urine culture and stone cultures can be a good choice for selecting antibiotics.