上尿路结石患者经皮肾镜取石术后全身炎性反应综合征危险因素分析

Risk factors of systemic inflammatory response syndrome after percutaneous nephrolithotripsy in patients with upper urinary tract calculi

目的探讨上尿路结石患者经皮肾镜取石术(PNL)后全身炎性反应综合征(SIRS)的危险因素。方法选取咸阳市中心医院自2015年7月至2018年7月收治的231例上尿路结石患者为研究对象。根据PNL后是否发生SIRS将其分为术后发生SIRS组(A组,n=72)与术后未发生SIRS组(B组,n=159)。记录并比较两组患者手术相关指标,包括手术时间、术中灌注速度、术中出血量、结石负荷、穿刺肾盏位置。采用多因素Logistic回归分析模型分析上尿路结石患者PNL后SIRS的危险因素。结果两组患者的手术时间、术中灌注量、术中出血量、结石负荷比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,术前患者伴发糖尿病、结石负荷偏高、肾功能不全是上尿路结石患者PNL后SIRS的危险因素(P<0.05)。结论上尿路结石患者围术期需控制血糖,降低对相关组织的损伤,并增强患者肾功能,以减少SIRS的发生。

Objective To investigate the risk factors of systemic inflammatory response syndrome(SIRS)after percutaneous nephrolithotripsy(PNL)in patients with upper urinary calculi.Methods A retrospective study was performed on 231 cases of patients with upper urinary calculi who were admitted from July 2015 to July 2018.According to the occurrence of SIRS after PNL,the patients were divided into the postoperative SIRS group(Group A,n=72)and the postoperative SIRS group(Group B,n=159).Operative indicators were recorded and compared between the two groups,including operative time,intraoperative perfusion velocity,intraoperative blood loss,stone load,and position of renal calyces punctured.The risk factors of SIRS after PNL in patients with upper urinary calculi were analyzed using a multivariate Logistic regression model.Results There were statistically significant differences between the two groups in operation time,intraoperative perfusion,intraoperative blood loss and stone load(P<0.05).Multivariate Logistic regression analysis showed that preoperative diabetes,high stone load,and renal insufficiency were the risk factors for POST-PNL SIRS in patients with upper urinary calculi(P<0.05).Conclusion In the perioperative period,patients with upper urinary calculi should control blood glucose,reduce damage to relevant tissues,and enhance renal function to reduce the occurrence of SIRS.