经皮肾镜术后发生尿源性脓毒血症的相关性危险因素的研究

A study on risk factors for urinary sepsis after percutaneous nephrolithotomy

目的评估经皮肾镜取石术(PCNL)后发生发热和尿脓毒血症的风险因素。方法选取2016年6月至2018年1月鄂州市中心医院诊治的60例肾结石患者(男38例,女22例)作为研究对象。所有患者进行术前调查,包括年龄、性别、BMI、DM、肾积水的程度、结石的数量和大小等。所有患者在麻醉诱导下静脉注射预防性抗生素。穿刺肾盂系统后,采集所有患者的肾盂尿液样本。术后仔细监测患者发热和脓毒血症的时期。结果手术的平均持续时间为77.08分钟,手术时间范围为40分钟~120分钟。所有患者都有术后肾造口管。17例(28.33%)患者在PCNL后发热的统计学显著性因素是糖尿病(DM)(P=0.001),结石负荷(P=0.001),结石数量(P<0.001),肾积水程度(P=0.001),手术持续时间(P<0.001)和残石(P=0.001)。PCNL脓毒症发生后有3例(5.00%)发生,统计学显示PCNL后脓毒症发生的重要危险因素是手术持续时间(P=0.013)和术中出血量,术后血红蛋白(HB)水平下降(P=0.046)。结论 DM、鹿角型结石、肾积水的程度、手术时间和结石数量是术后PCNL发热的危险因素,而失血、手术持续时间和残留结石是PCNL后脓毒症的危险因素。

Objective The aim of this study was to assess the risk factors for fever and urinary sepsis after percutaneous nephrolithotomy(PCNL). Methods 60 patients(38 males and 22 females) with renal calculi treated in Ezhou Central Hospital from June 2016 to January 2018 were selected as the study subjects. All patients were investigated before operation, including age, sex, BMI, DM, degree of hydronephrosis, number and size of stones. All patients underwent intravenous injection of prophylactic antibiotic gentamicin under induction of anesthesia. After puncturing the renal pelvis system, all patients′ urine samples were collected. Postoperatively, the period of fever and sepsis was carefully monitored. Results The average duration of operation was 77.08 minutes, ranging from 40 minutes to 120 minutes. All patients had postoperative renal stoma. The statistically significant factors for fever after PCNL in 17 patients(28.33%) were diabetes(DM)(P=0.001), stone burden(P=0.001), number of stones(P<0.001), and degree of hydronephrosis(P=0.001), duration of operation(P<0.001) and residual stone(P=0.001). 3 cases(5.00%) had sepsis after PCNL. Statistically significant risk factors for sepsis after PCNL were duration of operation(P=0.013), intraoperative blood loss, and the decline of postoperative hemoglobin(HB) level(P=0.046). Conclusions DM, antler stones, degree of hydronephrosis, duration of operation and number of stones are risk factors for fever after PCNL. Blood loss, duration of operation, and residual stones are risk factors for sepsis after PCNL.