经皮肾镜碎石取石术后全身炎症反应综合征的风险因素回顾性分析

Retrospective Analysis for the Risk Factors of Systemic Inflammatory Response Syndrome(SIRS) after Percutaneous Nephrostolithotomy(PCNL)

【目的】探讨经皮肾镜碎石取石(PCNL)术后发生全身炎症反应综合征(SIRS)的影响因素。【方法】回顾性分析2011年1月至2014年4月我院诊断泌尿系结石并行PCNL术患者资料415例,经过排除,最终纳入分析251例。对比SIRS组和非SIRS组其他围术期并发症的发生率,并对术后发生SIRS的可能相关因素进行单因素和Logistic多因素回归分析。【结果】1术后发生SIRS69例,未发生SIRS 182例,两组术前一般情况比较无统计学差异(P>0.05)。2SIRS组患者术后血红蛋白(HGB)≤90 g/L、肌酐(SCr)≥1.5倍基线值、术后住院≥8 d的发生率明显高于SIRS阴性患者,具有统计学差异(P<0.05)。3单因素分析结果显示:结石直径≥50 mm,铸型结石,尿培养阳性,手术时间≥120 min,通道大小,术中未使用右美托咪定与PCNL术后SIRS相关(P<0.05)。4Logistic多因素回归分析发现手术时间≥120 min(P=0.001,OR=3.011)、尿培养阳性(P=0.005,OR=5.48)、术中未使用右美托咪定(P=0.019,OR=2.099)为PCNL术后SIRS的独立危险因素。【结论】PCNL术后SIRS的发生受多个因素综合作用的影响,其中手术时间、尿培养阳性、术中未使用右美托咪定为PCNL术后SIRS的独立危险因素,可作为预测术后SIRS的依据。右美托咪定对PCNL术后SIRS的影响,有待进一步研究证明。

[ Objective ] To explore the risk factors of systemic inflammatory response syndrome （SIRS） after percutaneous nephrostolithotomy （PCNL）. [Methods] From May 2014 to March 2015, the data of 415 patients undergoing PCNL were analyzed retrospectivelyafter exclusion.Single-factor and Logistic multi-factor regression analysis were tested for risk factors of postoperative SIRS. [ Results] 69 patients were found with positive SIRS （SIRS＋ group, n = 69）, and 182 patients were negative SIRS （SIRS - group, n = 182）. No significant differences were seen in physical status between two groups. Significant difference were found on Postoperative HGB ≤ 90 g/L, SCr≥ 1.5 baseline, postoperative hospital stay ≥ 8 d between SIRS＋ group and SIRS - group （P 〈 0.05）.Single-factor analysis showed that stone diameter ≤ 50 mm （P = 0.034）, cast stone （P = 0.031 ）, positive rine culture （P 〈 0.002）, operation time≥ 120 min （P = 0.003）, Tube size （P = 0.093）, Dex （Dexmedetomidine） （P =0.029） were the main factors of SIRS after PCNL. Furthermore, operation time ≥ 120 min （P = 0.001,OR -- 3.011）, positive urine culture （P = 0.005,OR = 5.48）, and none Dex used （P = 0.019,OR=2.099） were considered to be the independent risk factors after PCNL in multi-factor Logistic regression analysis. [ Conclusion] JThere were multiple factors combination influenced SIRS after PCNL, the operation time, positive urine culture, and none DEX were considered to be the independent risk factors of SIRS after PCNL. As present, there is no relevant studies of DEX on SIRS after PCNL, further research was needed.