PCNL术后尿源性脓毒血症的危险因素及治疗研究

The study of risk factors and treatment for urosepsis after percutaneous nephrolithotomy

目的 探讨经皮肾镜取石术（PCNL）后尿源性脓毒血症发生的危险因素及治疗方法.方法 回顾性分析本院724例肾及输尿管上段结石行PCNL患者的临床病历资料,采用Logistic回归方法分析PCNL发生尿源性脓毒血症的危险因素.结果 724例患者术后发生尿脓毒血症13例,发生率为1.80％,所有患者均经积极抗感染、扩容及支持等治疗后痊愈.Logistic回归分析显示,患者术前尿路感染（OR =2.78）、手术时间（OR =2.55）,术中肾盂压力（OR=4.61）、年龄（OR =2.35）性别（OR =2.07）及合并糖尿病（OR=2.39）与尿源性脓毒血症的发生密切相关（P＜0.05）,而结石直径＞2 cm、数量、鹿角形结石及肾积水程度与尿源性脓毒血症的发生无显著相关性（P＞0.05）.结论 患者术前尿路感染、手术时间＞60 min、术中肾盂压力＞40 mmHg、女性、年龄≥60岁及合并糖尿病是PCNL术后发生尿源性脓毒血症的危险因素,识别和警惕尿源性脓毒血症发生的危险因素,是预防和治疗PCNL术后尿源性脓毒血症的关键.

Objectives To investigate the risk factors and treatment methods for urosepsis after percutaneous nephrolithotomy （PCNL）.Methods Clinical data of 724 patients underwent PCNL were retrospectively analyzed in our hospital.Risk factors for urosepsis after PCNL were analyzed using logistic regression.Rcsults Thirteen patients were （1.8%） developed urosepsis from 724 patients.All patients were recovered and discharged after treatments of antibiotics,rehydration and aid.Logistic regression analysis showed that preoperative urinary tract infection（OR =2.78）,operative time（OR =2.55）,intraoperative renal pelvis pressure （OR =4.61）,the elderly （OR =2.35）,sexuality （OR =2.07） and diabetes mellitus（OR =2.39） were closely related with urosepsis following PCNL.Stone diameter,quantity,staghorn calculi and nephrohydrops degree were not significantly correlated （P 〉 0.05） with urosepsis.Conclusions Preoperative urinary tract infection,operative time（〉60min）,intraoperative renal pelvis pressure （〉 40 mmHg）,woman,the elderly （≥ 60 years）and diabetes mellitus are the risk factors for urosepsis following PCNL.Perioperative identification of the related risk factors is the key for the prevention and treatment of urosepsis for PCNL.