经皮肾镜碎石术后致尿源性脓毒血症的危险因素研究

Clinical study of risk factors for urosepsis after percutaneous nephrolithotomy

目的 总结经皮肾镜气压弹道碎石治疗肾结石术后尿源性脓毒血症的危险因素.方法 收集本院2013年5月至2016年4月间行经皮肾镜气压弹道碎石治疗肾结石的患者临床资料,共657例,术后出现尿源性脓毒血症15例.总结病例特点,对可能导致尿源性脓毒血症的相关因素进行分析.结果 在15例尿源性脓毒血症患者中,术前尿常规、中段尿培养、术前使用抗生素、手术时间、术中液体灌注量等因素与术后尿源性脓毒血症相关.术前使用抗生素、手术时间、液体灌注量为尿源性脓毒血症的危险因素.结论 术前充分抗感染治疗、缩短手术时间以及减少术中液体灌注是减少术后尿源性脓毒血症的主要措施.

Objectives To explore the risk factors of urosepsis after percutaneous nephrolithotomy（PNL） for reducing the occurrence of urosepsis.Methods From May 2013 to April 2016, the data of 657 patients were treated by PNL were analyzed retrospectively.Fifteen patients were found with urosepsis after surgery.Single-factor and multi-factor analysis were tested for relevant factors.Results Among those fifteen patients, Single-factor analysis revealed that urinalysis, urine culture, without preoperative treatment of antibiotics, the time of operation and the quantity of filling liquid were main factors for urosepsis after PNL.Furthermore, without preoperative treatment of antibiotics and overtime operation and the quantity of filling liquid were considered to the risk factors of urosepsis after PNL by multi-factor analysis.Conclusions Without preoperative treatment of antibiotics, longer operation time and a large number of filling liquid are considered to be the independent risk factors of urosepsis after PNL.For the high-risk patients, preoperative treatment of antibiotics, operative time shorter and less quantity of filling liquid can reduce urosepsis after PNL.