经皮肾镜取石术后感染的预警评分体系的构建研究

Establishment of an early warning score system for infection after percutaneous nephrolithotomy

目的构建经皮肾镜取石术(PCNL)后感染的预警评分体系并进行验证。方法联合本院泌尿外科、感染科、检验科、重症医学科、药学科中的相关专家组成专家组,结合文献报道、前期研究及临床实际经验,确定PCNL术后感染的高危因素并对其进行赋值,构建预警评分体系。回顾性分析本院2017年1月至2019年1月收治的患有肾结石并实施PCNL的122例病例的相关数据,对预警评分体系进行验证。结果预警评分表条目包括年龄≥65岁、术前尿路感染、结石直径≥3 cm、鹿角形结石、手术时间≥90 min、糖尿病,其中糖尿病进一步分层为是否伴有糖尿病并发症,评分表最高分值合计为12分。经Mann-Whitney U检验分析,122例病例中的感染组与非感染组间的预警评分结果比较,差异有统计学意义(P<0.001)。经截断值分析,截断值为7时约登指数最大,将预警评分中0~7.0分为低危组,7.1~12.0分为高危组,且低危组与高危组间的感染发生率比较,差异有统计学意义(P<0.001)。结论本研究中构建的预警评分表其内容明确、简单易行,能够帮助临床人员识别PCNL术后感染的高危人群。

Objective To establish and validate earlywarning scoring system for postinfection after percutaneous nephrolithotomy(PCNL).Methods The expert group was composed of relevant experts from the department of renal surgery,infection department,nursing department,clinical laboratory department,intensive care department and pharmacy department of our hospital.Combined with literature reports,preliminary studies and clinical practical experience,the high-risk factors for postoperative infection of PCNL were determined and assigned,and the earlywarning scoring system was established.The relevant data of 122 cases with kidney stones and the implementation of PCNL in our hospital from January 2017 to January 2019 were retrospectively analyzed to verify the earlywarning scoring system.Results The items of the early warning rating scale included age 65 years old,preoperative urinary tract infection,stone diameter 2 cm,antler stone,and operation time 90 min,and diabetes.Diabetes was further divided into diabetes complications,and the maximum score of the rating scale was 12 points in total.After analysis by mann-whitney U test there was a significant difference in the early warning score between the infected group and the non-infected group(P<0.001).According to the cut off value analysis,the Youden index was the highest at 7,and the early warning score(0-7.0)was divided into the low-risk group,and the early warning score(7.1-12.0)was divided into the high-risk group.The chi-square analysis showed a significant difference in the infection rate between the low-risk group and the high-risk group(P<0.001).Conclusions The early warning rating table constructed in this study is clear,simple and easy to implement,which can help clinical personnel identify high-risk groups of postoperative infection with PCNL.