微创经皮肾镜取石术后发生全身炎症反应综合征的多因素分析

Multivariate Analysis on Systemic Inflammatory Response Syndrome Following Minimally Invasive Percutaneous Nephrolithotomy

目的探讨微创经皮肾镜取石(minimally invasive percutaneous nephrolithotomy,MPCNL)术后发生全身炎症反应综合征(systemic inflammatory response syndrome,SIRS)的预后因素。方法回顾性分析2012年1月~2016年12月我科单侧一期MPCNL治疗上尿路结石173例临床资料,根据术后是否发生SIRS将患者分为2组,比较2组预后因素的差异,通过多因素logistic回归分析评价预后因素与术后发生SIRS的相关性。结果本组173例MPCNL手术均获成功,其中26例(15.0%)术后发生SIRS。与非SIRS组相比,SIRS组的结石负荷[(409.3±49.3)mm^2 vs.(370.7±77.7)mm^2,P=0.015]和术中灌注速度[(206.4±33.7)ml/min vs.(182.6±34.9)ml/min,P=0.002]均较高。合并糖尿病者MPCNL术后SIRS的发生率为30.0%(9/30),无糖尿病者为11.9%(17/143),差异有统计学意义(P=0.025)。多因素logistic回归分析结果显示,与术后SIRS发生相关的预后因素包括:糖尿病史(OR=2.998,95%CI 1.023~8.779,P=0.045),结石负荷≥400 mm^2(OR=3.038,95%CI 1.111~8.303,P=0.030),灌注速度≥200 ml/min(OR=4.969,95%CI 1.869~13.209,P=0.001)。结论糖尿病史、较高结石负荷以及较高的术中灌注速度,是一期MPCNL治疗上尿路结石术后SIRS的预后因素。

Objective To analyze prognostic factors of systemic inflammatory response syndrome（ SIRS） following minimally invasive percutaneous nephrolithotomy（ MPCNL） for upper urinary tract calculus. Methods We retrospectively analyzed the clinical data of 173 consecutive cases of upper urinary calculi treated by one-phase MPCNL between January 2012 and December 2016.The patients were divided into two groups as patients developing SIRS or not. The clinical data before and during operations were compared between the two groups. By using a logistic regression model,multivariate statistical analyses were performed to determine prognostic factors with significant relevance to the development of postoperative SIRS. Results The MPCNL procedures were successful in the 173 cases,and the incidence of SIRS after MPCNL was 15. 0%（ 26/173）. As compared with non-SIRS group,the SIRS group had higher mean stone burden [（ 409. 3 ± 49. 3） mm^2 vs.（ 370. 7 ± 77. 7） mm^2,P = 0. 015]and higher mean irrigation rate [（ 206. 4 ± 33. 7） ml/min vs.（ 182. 6 ± 34. 9） ml/min,P = 0. 002]. The rate of postoperative SIRS in patients with diabetes mellitus was 30. 0%（ 9/30）,higher than that in patients without diabetes mellitus [11. 9%（ 17/143）,P = 0. 025]. Multivariable logistic regression analysis identified diabetes mellitus history（ OR = 2. 998,95% CI 1. 023-8. 779,P = 0. 045）, stone burden ≥ 400 mm^2（ OR = 3. 038,95% CI 1. 111-8. 303,P = 0. 030）,and irrigation rate ≥ 200 ml/min（ OR = 4. 969,95% CI1. 869-13. 209,P = 0. 001） as prognostic factors with significant relevance to the development of SIRS following MPCNL.Conclusion Diabetes mellitus history,higher stone burden,increased irrigation rate are prognostic factors with significant relevance to SIRS following one-phase MPCNL for upper urinary tract calculus.