经皮肾镜碎石术治疗肾铸型结石性脓肾术后并发SIRS的危险因素

Risk Factors of SIRS after Percutaneous Nephrolithotomy for Renal Cast Stone with Pus Kidney

目的:探讨经皮肾镜碎石术(PCNL)治疗肾铸型结石性脓肾术后并发全身性炎症反应综合征(SIRS)的危险因素。方法:接受Ⅰ期PCNL治疗的肾铸型结石性脓肾患者168例,分为SIRS组(n=22)和非SIRS组(n=146),比较2组患者性别、年龄等一般资料、术后24 h患者肾功能和血脂指标、血清内毒素(ET)、降钙素原(PCT)及C反应蛋白(CRP)水平;对两组比较有差异指标进行Logistic回归分析,探讨并发SIRS的危险因素。结果:两组患者年龄、结石数量、手术时间、术前应用抗生素、肾功能不全、术前尿路感染、手术为单通道、是否需要输血、灌洗液流量>500 m L/min等因素比较,差异有统计学意义(P<0.05);SIRS组术后24 h血清CRP、ET、PCT水平显著高于非SIRS组(P<0.05);Logistic回归分析显示,结石数量为多发、灌洗液流量>500 m L/min、肾功能不全、术前尿路感染、手术为单通道、术后血清ET和PCT水平升高是并发SIRS的危险因素,术前应用抗生素为保护因素。结论:术前应用抗生素,术后监测血清ET、PCT水平可预防术后SIRS的发生。

Objective：To explore the risk factors of postoperative systemic inflammatory response syndrome（SIRS） after percutaneous nephrolithotomy（PCNL） for renal calculi complicated with pyonephrosis.Methods：168 cases of renal calculi complicated with pyonephrosis patients treated with PCNL I were divided into SIRS group（n = 22） and non SIRS group（n = 146）.Gender,age and other general data,renal function and blood lipids 24 h after operation,serum endotoxin（ET）,procalcitonin（PCT） and C reactive protein（CRP） levels were compared between the two groups,and Logistic regression analysis were used to analyze the risk factors of SIRS.Results：Age,stone number,operation time,preoperative use of antibiotics,renal insufficiency,preoperative urinary tract infection,surgery for single channel,whether need blood transfusion and lavage fluid flow 〉500 m L/min were different between the two groups（P〈0.05）.The postoperative levels of serum CRP,ET and PCT in SIRS group were significantly higher than those in non SIRS group（P〈0.05）.The results of Logistic regression analysis showed that t Logistic regression analysis showed that the number of stones was multiple,lavage fluid flow 〉500 m L/min,renal insufficiency,preoperative urinary tract infection,surgery for single channel,increase of postoperative serum ET and PCT levels were risk factors associated with SIRS,preoperative use of antibiotics were protective factors.Conclusions：Preoperative application of antibiotics,postoperative monitoring of serum ET,PCT levels can prevent the occurrence of postoperative SIRS.