微通道经皮肾镜取石术感染性休克危险因素分析

Risk factors of septic shock after mini-percutaneous nephrolithotripsy

目的探讨微通道经皮肾镜取石术(m PCNL)发生感染性休克的危险因素。方法对2013年1月-2014年12月该科经治的1 590例m PCNL患者的临床资料进行回顾性分析,采用单因素χ~2检验和Logistic回归分析法分析m PCNL术后发生感染性休克的危险因素。结果术后18例患者发生感染性休克,其中男6例,女12例,年龄28~69岁,平均(45.6±13.5)岁,术前尿常规白细胞(WBC)阳性率100.00%,结石直径1.5~5.0 cm,单通道取石15例,多通道3例,手术时间45~200 min,平均(87.0±56.0)min,18例患者中2例因继发多器官功能衰竭而死亡,余好转出院。χ~2分析结果显示女性、术前尿常规WBC(+++^++++)、术前未行肾造瘘与感染性休克的发生相关,Logistic回归分析显示女性、术前未行肾造瘘与感染性休克的发生相关。结论女性、术前未行肾造瘘是m PCNL术后发生感染性休克的危险因素。

Objective To evaluate the risk factors of septic shock after mini-percutaneous nephrolithotripsy （mPCNL）. Methods Clinical data of 1 590 eases who underwent mPCNL from January 2013 to December 2014 were retrospectively analyzed. The X2 test and logistic regression were used to identify the key risk factors for septic shock after mPCNL. Results Of the 1 590 patients, 18 patients suffered septic shock, including 6 male patients and 12 fe- male patients. Their mean age was （45.6 ± 13.5） years （28 - 69 years）. White cell in urine was 100 percent, the stone diameter ranged from 1.5 to 5.0 cm, unichannel for 15 cases while muhichannel for 3 cases, the operation du- ration ranged from 45 to 200 rain, mean （87.0 ± 56.0） rain. 2 in 18 cases died in multiple organ failure, the others recovered till discharged. In X： test, female gender （P = 0.001）, （＋＋＋ -＋＋＋＋） white cells in urine （P = 0.042）, un-preoperative nephrostomy drainage （P = 0.041） had significant association with septic shock after mPCNL. While in multivariate analysis, female gender （OR = 5.471, 95 % CI： 0.756-21.452, P 〈 0.05） and un-preoperative nephrostomy drainage （OP,, = 3.106, 95 % CI： 1.283-7.907, P 〈 0.05） were identified as independent risk factors for septic shock after mPCNL. Conclusions Female gender and un-preoperative nephrostomy drainage are the key risk factors for septic shock after mPCNL.