术中使用地塞米松对经皮肾镜术后全身炎症反应综合征影响的回顾性研究

Retrospective analysis for the effect of Dexamethasone on systemic inflammatory response syndrome after percutaneous nephrolithotomy

目的探讨地塞米松对经皮肾镜碎石取石术(PCNL)术后全身炎症反应综合征(SIRS)的影响。方法本研究回顾性收集了2011年1月到2015年3月在我院泌尿外科诊断泌尿系结石并行PCNL的患者病例资料486例,经排除最终纳入369例患者进行数据分析,并根据术中是否使用地塞米松分为两组,对比术后SIRS的发生率及其他预后指标。结果(1)纳入地塞米松组[DEX(+)组]有209例患者,非地塞米松组[DEX(–)]组有160例患者,两组患者术前基线临床资料差异无统计学意义(P>0.05);(2)术中情况对比,DEX(+)组的手术时间更长(106±74)min vs(81±58)min,P<0.001);需要使用血管活性药物的比例更高(22.5%vs 8.8%,P<0.001),其他指标如输血比例和经皮通道大小两组差异无统计学意义(P>0.05);(3)主要结局指标:两组发热的发生率、SIRS的发生率和发生SIRS的严重程度差异无统计学意义(P>0.05);(4)次要结局指标:DEX(+)组低血压发生率更高(14.8%vs 7.5%,P=0.03),血红蛋白下降水平更大[(11.6±2.0)g/L vs(8.0±2.3)g/L,P<0.001)],其他指标如术后肾功能变化和住院时间差异无统计学意义。结论术中使用地塞米松对PCNL术后SIRS的发生未提示有预防作用,仍需要更多的研究进一步验证。

Objective To explore the effect of Dexamethasone on systemic inflammatory response syndrome(SIRS)after percutaneous nephrolithotomy(PCNL)Methods There were 486 patients diagnosed with renal calculi and received PCNL in the Third Affiliated Hospital,Sun Yat-sen University from January 2011 to March 2015.After exclusion,369 cases were included in the statistical analysis.And the patients were divided into two groups according to whether Dexamethasone was used during the operation.The incidence of fever and SIRS,and the data of other prognostic indicators were recorded.Results There were 209 cases in the group Dexamethasone DEX(+),160 cases in the other group DEX(–),there was no significant different between two groups about the baseline indicators(P>0.05).The operation time of group DEX(+)was longer than group DEX(–)[(106±74)min vs(81±58)min,P<0.001],the proportion of patients required to use of vasoactive drugs was higher in group DEX(+)(22.5%vs 8.8%,P<0.001),there were no significant difference in the need to transfusion or the size of between the two groups tube(P>0.05).The primary outcomes:there were no significant difference in the incidence of SIRS,fever,score of SIRS(P>0.05);The secondary outcomes:The incidence of postoperative hypotension was higher in group DEX(+)(14.8%vs 7.5%,P=0.03),the reduction of HGB level in group DEX(+)was more than group DEX(–)[(11.6±2.0)g/L vs(8.0±2.3)g/L,P<0.001],there were no significant difference in postoperative renal function and length of hospital stay between the two groups(P>0.05).Conclusions It dose not suggest that the intraoperative use of Dexamethasone has a preventive effect on the occurrence of SIRS after PCNL,however,further studies are needed to verify it.