应用中心静脉导管行经皮肾造瘘与经尿道输尿管镜置管在尿源性脓毒血症紧急解压治疗中的疗效比较

Comparison of the efficacy of percutaneous nephrostomy with central venous catheter and transurethral ureteroscopic catheterization in the emergency decompression of urinary sepsis

目的 比较应用中心静脉导管行经皮肾造瘘与经尿道输尿管镜置管两种方法在治疗急性输尿管结石梗阻致尿源性脓毒血症的疗效,为临床治疗提供新思路.方法 收集2013年6月至2018年6月在本院收治158 例尿源性脓毒血症患者的临床资料,其中实验组(86例)应用中心静脉导管行经皮肾穿刺造瘘;对照组(72例)输尿管镜下逆行置双J管引流.对两组一般资料、治疗方法、临床疗效等资料进行评价.结果 两组患者的性别、年龄、发病时间、病史情况、术前感染指标、手术成功率比较差异均无统计学意义(P>0. 05).实验组的手术用时短于对照组[(16. 0 ± 4. 3)min vs. (20. 9 ± 6. 7)min,P<0. 05].实验组术后体温恢复正常的时间短于对照组[(1. 2 ± 0. 5)d vs. (2. 3 ± 0. 6)d,P<0. 05],实验组在术后脓毒血症控制时间短于对照组[(4. 5 ± 1. 1)d vs. (6. 0 ± 1. 3)d,P<0. 05],实验组术后感染性休克的发生率明显低于对照组(1. 16% vs. 9. 72% ,P<0. 05).结论 采用中心静脉导管行经皮肾造瘘与输尿管镜下置管两种引流方法治疗尿源性脓毒症均安全有效,但采用中心静脉导管行经皮肾造瘘术能在更短的时间内达到控制感染的目的,临床治疗效果总体优于输尿管镜下置管.因其管径小,创伤小,均可在床边局麻下完成,方便快捷,疗效确切,值得在急性输尿管结石梗阻致尿源性脓毒血症的患者中推广.

Objective To investigate the effects and advantages of central venous catheter for percutaneous nephrostomy and transurethral ureteral catheter insertion in the treatment of emergency ureteral calculus obstruction induced urinary sepsis.Methods From June 2013 to June 2018,a retrospective analysis about clinical data of 86 patients with the urinary sepsis treated with central venous catheter for percutaneous nephrostomy(experimentiil group)and 72 patients treated with transurethral ureteral catheter insertion(control group).The general condition,curative effects,complication and other information from two groups were evaluated.Results The genal clinical data between the two groups had no significant difference(P〉0.05).The achievement ratio of operation between the two group had no significant difference(P>0.05).The operation time of the experimental group was shorter than control group[(16.0±4.3)min vs.(20.9±6.7)min<0.05].The recovery time of postoperative body temperature in the experimental group was shorter than control group[(1.2±0.5)d vs.(2.3±0.6)d,P<0.05],The recovery time of postoperative sepsis in the experimental group was shorter than control group[(4.5±1.1)d vs.(6.0±1.3)d,P<0.05],The incidence of postoperative septic shock in the experimental group was significantly lower than control group(1.16%vs.9.72%,P<0.05).There was no statistically significant difference in hemorrhage and detubation between the two groups(P>0.05).Conclusions Both central venous catheter for percutaneous nephrostomy and transurethral ureteral catheter insertion are safe and effective for the treatment of urinary sepsis.But Percutaneous nephrostomy with central venous catheter can control infection in a shorter time,is more effective in preventing the aggravation of infection,it is better than transurethral ureteral catheter insertion,which is worth of being generalized.