尿源性脓毒血症的相关因素分析及早期诊断和治疗

Analysis of related factors and early diagnosis and management in urinary sepsis

目的 分析发生尿源性脓毒血症的相关因素,总结其早期诊断及治疗经验,为临床治疗提供理论指导与依据.方法 回顾性分析2007年至2015年本院收治的43例尿源性脓毒血症患者的临床资料,发现诱发感染的相关因素,采用SPSS 16.0软件进行统计分析.结果 43例尿源性脓毒血症患者中,60岁以上28例（65.12%）,女性26例（60.47%）;本组患者中合并糖尿病共有29例（67.44%）、合并慢性肾功能不全共有24例（55.81%）、鹿角型结石22例（51.16%）、体外冲击波碎石治疗后6例（13.95%）.中段尿细菌培养阳性39例（90.70%）,其中大肠杆菌27例（69.23%）,阴沟肠杆菌10例（25.64%）,肠球菌2例（5.13%）,尿培养阴性4例（9.30%）.其中22例鹿角型结石行经皮肾镜钬激光碎石治疗后出现尿源性脓毒血症.相关因素分析结果显示,年龄＆gt;60岁、女性、患有糖尿病、合并慢性肾功能不全、尿培养阳性、鹿角型结石、手术时间过长、高肾盂压力、术后引流不畅是尿源性脓毒血症患者并发感染的相关因素;其首发症状多样化,所有患者治疗后均痊愈出院,无明显后遗症.结论 尿源性脓毒血症时诱发感染因素较多,早期发现相关因素并及时积极加以控制有利于防止其临床发生与发展,获得良好的预后.

Objectives To investigate the related factors of urinary sepsis and provide theory guidance in early diagnosis and management for clinical treatment.Methods A retrospective analysis of the clinical data of 43 urinary sepsis patients from 2007 to 2015 were assessed to find the related factors.SPSS 16.0 software was used for statistics.Results Twenty-eight patients （65.12%） were older than 60 years, 26 cases were female （60.47%）.There were 29 cases with diabetes （67.44%）, 24 cases with chronic renal dysfunction （55.81%）, 22 cases with staghorn （51.16%）, and 6 cases administrated after ESWL （13.95%）.Positive results with midstream urine culture were observed in 39 cases （90.70%） including 27 cases with escherichia coli （69.23%）, 10 cases with enterobacter cloacae （25.64%）, 2 cases with enterococcus （5.13%）.There were 21 cases with urinary sepsis after PCNL.Multiple analysis results showed risk factors of urinary sepsis as follows： older than 60 years, female gender, diabetes, chronic renal dysfunction, positive midstream urine culture, staghorn, long operative time, high pelvis pressure and poor drainage after operation.No sequelas was observed in all cases.Conclusions Urinary sepsis induced infection factors are more , early detection of relevant factors and timely and proactive control is conducive to prevention for its clinical occurrence and development and obtain a good prognosis.