输尿管软镜钬激光碎石术致感染性休克的早期预警性研究

Early Warning Study of Septic Shock by Flexible Ureteroscopy Combined with Holmium Laser Lithotripsy

目的探讨输尿管软镜钬激光碎石术致感染性休克的早期预警指标,从而为临床尽早诊断、早处理提供依据。方法回顾性分析2010年1月至2014年10月输尿管软镜钬激光碎石术的临床资料,术后发生急性感染性休克患者共5例,年龄30-58岁,平均45.3岁。分别收集并分析患者术前及术后各时间段的血常规、C反应蛋白等实验室指标变化。分析数据结果,来探讨输尿管软镜钬激光碎石术致感染性休克的早期指标。结果本组5例患者中血白细胞(WBC)及中性粒细胞(NE)术后2h与术前相比明显下降(P<0.05),而术后12h与术前相比则明显上升(P<0.05);降钙素原(PCT)术后2h与术前相比明显上升(P<0.05);超敏C反应蛋白(CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-a(TNF-a)术后2小时内升高不明显,但术后12小时开始明显升高(P<0.001)。结论血白细胞或粒细胞、降钙素原是输尿管软镜钬激光碎石术致感染性休克的最为重要的早期预警指标。

Objective to study the early warning indicators of septic shock by flexible ureteroscopy combined with holmium laser lithotripsy, and provide basis for clinical diagnosis and early treatment as soon as possible. Methods Retrospective analyze clinical data of flexible ureteroscopy combined with holmium laser lithotripsy,from January 2010 to October 2014, 5 patients was acute septic shock,30- 58 years old, average 45.3 years. Collect and analyze respectively in patients with preoperative and postoperative routine blood of each time period, laboratory indexes, such as c- reactive protein changes. Analysis results, to study the early warning indicators of septic shock by flexible ureteroscopy combined with holmium laser lithotripsy. Results 5 cases of white blood cells（WBC） and blood neutrophils（NE）2 h after surgery compared with preoperative significantly decreased（P〈0.05）, compared with the preoperative and postoperative 12 h was significantly increased（P〈0.05）; PCT 2 h after surgery compared with preoperative rise significantly（P〈0.05）; CRP and interleukin 6（IL- 6）, tumor necrosis factor-（TNF- a） increased significantly after 12 hours（P 0.001）. Conclusion The most important early warning indicators of septic shock by flexible ureteroscopy combined with holmium laser lithotripsy was Blood leukocytes or granulocyte, calcitonin.