输尿管软镜钬激光碎石术后全身炎症反应综合征的风险因素评估

Risk factors of systemic inflammatory response syndrome following flexible ureteroscopic lithotripsy

目的：探讨输尿管软镜钬激光碎石术（FUL）术后发生全身炎症反应综合征（SIRS）的风险因素。方法：分析2012年10月~2014年11月间260例患者临床资料,按术后是否发生SIRS分组,单因素分析比较年龄、性别、BMI、结石大小、尿路感染、肾积水、灌注、输尿管通道鞘、手术时间、结石成分等风险因素,随后通过多因素逻辑回归分析,计算Odds比值（OR）和95%可信区间（95%CI）以确定FUL术后SIRS的独立风险因素。结果：FUL术后SIRS发生率8.1%（21/260）。在单因素分析中,SIRS与患者性别（P〈0.01）、结石大小（P=0.001）、灌注速度（P〈0.01）及灌注量（P〈0.01）有显著相关性。多因素逻辑回归分析确定结石大小（OR=1.691,95%CI：0.879~3.255）、小口径输尿管通道鞘（OR=2.293,95%CI：0.730~7.200）、灌注速度（OR=1.161,95%CI：1.096~1.230）及感染性结石（OR=3.331,95%CI：0.971~11.426）为FUL术后SIRS的独立风险因素。结论：结石大负荷、感染性结石是FUL术后SIRS危险因素,具有这些危险因素的患者FUL时应控制手术时间,必要时分期手术;FUL术中宜使用低压低流灌注,并使用大口径输尿管通道鞘提供引流,用以降低FUL术中肾盂内压。

Objective：To evaluate the risk factors of systemic inflammatory response syndrome（SIRS）after flexible ureteroscopic lithotripsy（FUL）.Method：Data from 260 patients who underwent FUL from October 2012 to November 2014 were retrospectively reviewed.The potentially risk factors of SIRS,such as age,sex,BMI,stone size,urinary tract infection,hydronephrosis,perfusion,ureteral access sheath,operation time,stone composition,et al were compared with univariate test in patients who developed postoperative SIRS.Then multivariable logistic regression analysis was performed and the odds ratio（OR）and 95% confidence interval（95%CI）were calculated to identify the independent risk factors.Result：The incidence of SIRS after FUL was 8.1%（21/260）.In the univariate test analysis,significant correlation between SIRS and four factors was noted：sex（P 0.01）,stone size（P =0.001）,irrigation flow rate（P 0.01）and irrigation volume（P 0.01）.Multivariable logistic regression analysis identified stone size（OR=1.691,95%CI：0.879-3.255）,small-caliber ureteral access sheath（UAS）（OR=2.293,95%CI：0.730-7.200）,irrigation flow rate（OR=1.161,95%CI：1.096-1.230）and struvite calculi（OR=3.331,95%CI：0.971-11.426）as independent risk factors for SIRS after FUL.Conclusion：Large stone burden and struvite calculi are risk factors for SIRS after FUL,shorten operation time or staging procedures are required in these patients.Irrigation with low flow rate and low pressure,and using a large-caliber UAS for better drainage are required to keep a low renal pelvic pressure during FUL procedure.