经皮肾镜取石术治疗老年上尿路结石患者术后全身炎症反应综合征的危险因素

Risk factors of postoperative systemic inflammatory response syndrome in elderly patients with upper urinary tract calculi treated by percutaneous nephrolithotomy

目的探讨经皮肾镜取石术治疗老年上尿路结石患者术后全身炎症反应综合征(systemic inflammatory response syndrome,SIRS)的危险因素。方法回顾性分析95例老年上尿路结石经皮肾镜术后患者临床资料,评估术前术中各种因素与术后SIRS的相关性。结果 95例患者中,SIRS表现22例(23.2%),其中2例发生感染性休克,经积极抗感染和支持治疗后痊愈,无死亡病例。SIRS组糖尿病史、反复尿路感染史、术前尿培养阳性率、鹿角形结石率、结石负荷和手术时间均明显高于或多于非SIRS组,差异有统计学意义(P<0.05);Logistic回归分析显示,反复尿路感染病史、鹿角形结石、糖尿病史是老年人经皮肾镜术后SIRS发生的危险因素。结论对于有反复尿路感染病史、鹿角形结石及糖尿病史的老年患者要提高警惕,术前积极控制感染,术中注意避免集合系统损伤,术后严密监控,以降低SIRS发生率。

Objective To investigate the risk factors of systemic inflammatory response syndrome(SIRS)in elderly patients with upper urinary calculi treated by percutaneous nephrolithotomy.Methods A retrospective analysis of95elderly patients with upper urinary calculi after percutaneous nephrolithotomy was performed to evaluate the correlation between the various factors and the postoperative SIRS.Results Of the95patients,22(23.2%)had SIRS,of which2had septic shock.After active anti-infection and supportive treatment,the patients recovered without death.History of diabetes mellitus,repeated urinary tract infection,positive rate of preoperative urine culture,the rate of staghorn calculi,stone load and operation time in SIRS group were significantly higher than those in non-SIRS group,and the difference was statistically significant.Logistic regression analysis showed that history of recurrent urinary tract infection,staghorn calculi,and diabetes mellitus were risk factors for SIRS in elderly patients after percutaneous nephroscopy.Conclusion For elderly patients with history of recurrent urinary tract infection,staghorn calculi and diabetes mellitus,vigilance should be raised,infection should be actively controlled before operation,renal collecting system damage should be avoided during operation,and strict monitoring after operation should be done to reduce the incidence of SIRS.