经皮肾镜取石并发尿源性脓毒血症风险评估系统的建立及评价

Establishment and evaluation of risk assessment scoring system for complicating urosepsis after percutaneous nephrolithotomy

目的建立经皮肾镜取石(PCNL)术并发尿源性脓毒血症术前风险评估系统并对其进行评价。方法根据PCNL术后尿源性脓毒血症相关危险因素的Meta分析结果,对各危险因素按其关联程度予以赋值评分,建立术前风险评估系统;回顾性收集该院2013年1月至2016年12月收治的行PCNL手术患者相关资料,使用已建立的风险评估系统进行评估,运用受试者工作特征(ROC)曲线检验其评估效果。结果根据Meta分析确立女性、年龄(≥60岁)、糖尿病、血常规(白细胞≥10×109/L)、尿常规(白细胞≥1+)、尿培养(阳性)、结石大小(≥2cm)、鹿角形结石、肾积水(中重度)9个危险因素,按关联强度分别赋值3、2、3、2、2、2、2、3、2分,总分21分,建立PuRass术前风险评估系统;共收集行PCNL手术患者293例,术后并发尿源性脓毒血症10例,293例患者得分0～16分,平均(4.97±3.19)分,尿源性脓毒血症组与非尿液性脓毒血症组比较差异有统计学意义(P<0.05)。PuRass模型评估后ROC曲线下面积为0.913,其截断点在8.5分时灵敏度和特异度分别为90.0%和89.4%;其风险分级为:低风险0～7分,中等风险8～14分,高风险15～21分。结论建立的术前风险评估系统可初步评估行PCNL手术患者术后并发尿源性脓毒血症的风险程度,对于评分高于8.5分的高危患者,临床医师在围术期应给予足够重视。

Objective To establish and evaluate the risk assessment scoring system for complicating urosepsis after percutaneous nephrolithotomy(PCNL).Methods According to the meta-analysis results of the risk factors related to urosepsis after PCNL,the scores were assigned to the risk factors according to their degree of association,the preoperative risk assessment scoring system was established;the related data of the patientstreated by PCNL in this hospital from January 2013 to December 2016 were retrospectively collected and assessed by using the constructed risk assessment scoring system.The assessment effect was tested by using the ROC curve.Results The meta analysis established 9 risk factors of female,age(≥60 years old),diabetes mellitus,blood routine(white blood cells≥10×10 9/L),urine routine(white blood cells≥1+),urine bacterial culture(positive),stone size(≥2 cm),staghorn stone and hydronephrosis(moderate-severe),which were respectively assigned the values as 3,2,3,2,2,2,2,3,2 points based on the association intensity,with the total score of 21 points.The PuRass preoperative risk assessment scoring system was established.A total of 293 cases of PCNL were collected and 10 cases had complicating urosepsis,293 cases had the score of 0-16 points,with an average score of(4.97±3.19)points.The difference between the groups was statistically significant(P<0.05).After PuRass model assessment,the area under the ROC curve was 0.913,at the cut-off point of 8.5 points,the sensitivity and specificity were 90%and 89.4%respectively.The risk degrees were the low risk(0-7 points),medium risk(8-14 points)and high risk(15-21 points).Conclusion Establishing the preoperative risk assessment scoring system can preliminarily assess the risk degree of complicating urosepsis after PCNL,the clinicians should pay enough attention to the high risk patients with above 8.5 points during the perioperative period.