经皮肾镜碎石取石术后尿源性脓毒血症休克的防治

Prevention of Uroseptic Shock after Percutaneous Nephrolithotomy

目的：总结探讨经皮肾镜碎石取石术（Percutaneous Nephrolithotomy,PCNL）并发尿源性脓毒血症休克的防治措施。方法：回顾性分析2010年1月至2014年11月治疗的714例PCNL患者,其中9例术后并发尿源性脓毒血症患者的临床资料。9例患者术后1~4 h内出现寒战、呼吸急促（呼吸〉30次/min）、高热（体温〉39.0℃）,心率加快（120~160次/min）,血压下降（〈90/60mm Hg）,血常规提示白细胞〉20×109/L或〈4×109/L,血小板〈60×109/L。临床诊断为尿源性脓毒血症休克,给予抗感染、抗休克等治疗。结果：早期由于认识及经验不足,3例患者因多器官功能衰竭死亡。在总结早期经验的基础上,加强围手术期预防并早期及时治疗,后期6例患者治愈出院。结论：PCNL术后尿源性脓毒血症休克起病急、发展迅速,加强围手术期的预防,早期诊断并及时治疗,能有效降低术后尿源性脓毒血症休克的发生率及病死率。

Objective： To summerize and explore the prevention of uroseptic shock after percutaneous nephrolithotomy. Methods：Clinical data of 714 PCNL patients from January 2010 to November 2014 were retrospectively analyzed, among them, 9 were with uroseptic after percutaneous nephrolithotomy. All 9 patients were characterized by chills, a breathing over 30 BPM, a temperature over39.0 ℃, a heart rate from 120 to 160 BPM and a blood pressure below 90/60 mm Hg within 1-4 hours after operation. They were diagnosed with uroseptic shock by clinical manifestations and were treated by anti-infection and anti-shock therapies. Results： At early stage, due to the lack of knowledge and experience, 3 patients died of multiple organ dysfunction failure. 6 patients were cured with early diagnosis and rapid treatment after summarizing the cause of failure. Conclusion： Uroseptic shock can develop rapidly after percutaneous nephrolithotomy. Effective prevention, early diagnosis and treatment can prevent uroseptic shock.