输尿管软镜碎石术后尿源性脓毒症的影响因素和生存质量研究

Study on the influencing factors of uremic sepsis after flexible ureteroscopic lithotripsy and the quality of life of patients

目的研究输尿管软镜碎石术后尿源性脓毒症的影响因素以及调查患者生存质量。方法选取2014年1月至2018年12月蚌埠市第一人民医院行输尿管软镜碎石术治疗的130例上尿路结石患者临床资料作为研究对象。对这130例患者作回顾性分析。根据术后是否发生尿源性脓毒症分为尿源性脓毒症组(n=50)及未发生组(n=80),对两组基本资料进行比较后,利用多因素Logistic回归分析法总结输尿管术后尿源性脓毒症的独立影响因素。结果两组患者性别、年龄、病程时间、手术时间、一次结石清除率、结石直径、肾积水程度、白蛋白、尿素氮差异无统计学意义(P>0.05),血小板计数、结石CT值、有无合并糖尿病、体温、心率、呼吸频率、C反应蛋白、血常规(白细胞计数、中性粒细胞百分比)相比较,差异具有统计学意义(P<0.05);多因素Logistic回归分析结果提示,血小板计数减少、结石CT值>1000HU为输尿管术后尿源性脓毒症的独立影响因素,差异具有统计学意义(P<0.05);两组生存质量相比较,未发生组高于尿源性脓毒症组,差异具有统计学意义(P<0.05)。结论血小板计数减少、结石CT值>1000HU为输尿管术后尿源性脓毒症的独立影响因素并且发生尿源性脓毒症的患者生存质量更低。

Objective To study the influencing factors of urinary sepsis after flexible ureteroscopic lithotripsy and to investigate the quality of life of patients.Methods The clinical data of 130 cases of upper urinary tract calculi treated by flexible ureteroscope lithotripsy in our hospital from January 2014 to December 2018 were retrospectively analyzed.According to the occurrence of urinary sepsis after operation,they were divided into urogenic sepsis group(50 cases)and non-occurrence group(80 cases).Independent influencing factors were analyzed through multivariate Logistic regression analysis.Results There was no significant difference in sex,age,duration of disease,operation time,clearance rate of primary stone,stone diameter,hydronephrosis degree,albumin and urea nitrogen between the two groups(P>0.05).There were statistically significant differences in the platelet count,CT value of calculi,presence or absence of diabetes mellitus,body temperature,heart rate,respiratory rate,C-reactive protein,blood routine(white blood cell count,percentage of neutrophils)between the two groups(P<0.05).The results of multivariate Logistic regression analysis showed that decreased platelet count and CT value>1000 HU were independent influencing factors of uremic sepsis after ureterectomy(P<0.05).The quality of life in the non-occurrence group was higher than that in the uremic sepsis group,with statistically significant differences(P<0.05).Conclusions Decreased platelet count and CT value>1000 HU are independent influencing factors of uremic sepsis after ureterectomy and the quality of life of patients with uremic sepsis decreased.