术前尿白细胞计数和尿培养与输尿管镜钬激光碎石取石术后SIRS发生的相关性

Correlation between urinary leukocyte count and urine culture before operation and the occurrence ofSIRS after ureteroscopic holmium laser lithotripsy

目的分析术前尿白细胞计数和尿培养与输尿管镜钬激光碎石取石术后全身炎症反应综合征(SIRS)发生的相关性。方法随机抽取2018年8月~2019年10月湛江市第四人民医院泌尿外科收治上尿路结石行输尿管镜钬激光碎石术(URL)患者60例作为研究对象,均在术前收集中段尿,术中留取肾盂尿、留取结石样本行细菌培养,在术后予以抗生素抗感染,收集术后发生SIRS、未发生SIRS患者(分别设为A组、B组)的资料,并分析组间数据差异。结果 A组感染部位最高者为泌尿系统、病原菌感染最高者为大肠埃希菌;A组性别、围术期是否输血、血红蛋白水平、白蛋白水平、术前尿细菌培养结果、术前尿白细胞检测结果、术前是否发生肾积水、肾功能是否不全、既往ESWL史、是否合并糖尿病、结石病灶位置与B间比较,差异无统计学意义(P> 0.05);A组年龄、既往感染性结石率、NLR水平、肾盂内压分布情况、结石负荷水平、手术时间、术后1d细菌毒素水平与B组比较,差异有统计学意义(P <0.05);经Logistic回归分析显示,高龄、既往感染性结石、高肾盂内压、结石负荷水平、手术时间、NLR、术后1d细菌毒素均是影响术前尿白细胞计数、尿培养结果与URL术后采用抗感染患者发生SIRS相关性的危险因素(P <0.05)。结论术前开展尿白细胞计数、尿培养检验,并予以相应的抗生素,有助于降低输尿管镜钬激光碎石取石术后SIRS发生风险。

Objective To analyze the correlation between urinary leukocyte count and urine culture before operation and the occurrence ofsystemic inflammatory response syndrome(SIRS) after ureteroscopic holmium laser lithotripsy(UHLL). Methods 60 patients with upper urinary tract calculi treated by UHLL from August 2018 to October 2019 in Department of Urology of No. 4 People’s Hospital of Zhanjiang were simply and randomly selected as the subjects of research. For both of the groups, midstream urine was collected before operation, renal pelvis urine was collected andcalculus samples were collected during operation for bacterial culture, and antibiotics were given after operation to resist infection.The data of the patients with postoperative SIRS and those without postoperativeSIRS(respectively set as group A and group B) were collected, and the differences between the groups in thedata were analyzed. Results In group A, the urinary system was the site with the severest infection, and Escherichia coli(E. coli) was the pathogen with the severest infection. There was no statistically significant difference between group A and group B in the data of gender, perioperative blood transfusion or not, hemoglobin level, albumin level, preoperative urine bacterial culture results, preoperative urine leukocyte detection results, preoperative hydronephrosis or not, renal insufficiency or not, previous ESWL history, combined diabetes mellitus(DM) or not, and calculus lesion location(P > 0.05). There were statistically significant differences between group A and group B in the data of age, previous infectious calculus rate, NLR level, intrapelvic pressure distribution, calculus load level, operation time and bacterial toxin level on the 1 st d after operation(P < 0.05). Logistic regression analysis showed that advanced age, previous infectious calculus, high intrapelvic pressure, calculus load level, operation time, NLR, and bacterial toxin on the 1 st d after operation were all risk factors that affected the correlation between preoperative urinary leukocyte count, urine culture results and the occurrence of SIRS to the patients given anti-infective therapy after UHLL(P < 0.05). Conclusion Pre-operative urinary leukocyte count, urine culture test and corresponding antibiotics are helpful to reducing the risk of SIRS after UHLL.