经皮肾镜取石术治疗复杂性肾结石术后感染性并发症的危险因素及其预测指标分析

Risk fctrs and pedlictors of ifecioes copleaios after percutaneous nephrolthotomy for complex renal calculi

目的通过对行经皮肾镜取石术(PCNL)的复杂性肾结石患者的相关感染因素进行分析,探讨其术后出现尿脓毒血症的危险因素,并分析其术前尿白细胞(WBC)与亚硝酸盐(NIT)的联合预测效能,为PCNL术后尿脓毒血症提供早期医学决策与依据。方法回顾性研究2018年9月至2019年12月期间于本院泌尿外科诊断为复杂性肾结石并行PCNL治疗的200例患者的临床资料,并将其中72例术后出现感染性并发症的患者纳入观察组,128例术后未出现感染性并发症的患者纳入对照组。通过筛选组间有差异性的指标,并采用了logistic分析探讨其独立危险因素;采用受试者工作特征(ROC)曲线分析其术前尿WBC与NIT的预测效能。结果观察组尿培养阳性率、多重耐药菌(MDROS)阳性率、术前尿WBC阳性率、术前尿NIT阳性率、结石培养阳性率、手术时间均显著高于对照组,差异有统计学意义(P<0.05);尿WBC(OR=2.250,P=0.048)、尿NIT(OR=5.833,P=0.031)、结石培养阳性(OR=2.667,P=0.001)、尿培养阳性(OR=5.444,P=0.035)、手术时间(OR=8.071,P=0.009)为PCNL术后尿脓毒血症的独立危险因素;术前尿WBC联合NIT预测尿结石培养阳性的曲线下面积(AUC)为0.939。结论术前尿WBC、NIT、结石培养阳性率、尿培养阳性、手术时间为尿脓毒血症的独立危险因素。术前尿WBC与NIT联合检测预测尿培养与结石培养阳性具有较好的效能,能为复杂性肾结石PCNL术后发生尿脓毒血症提供早期医学决策与依据。

Objective To explore the risk factors of urinary sepsis through the infection factors related to percutaneous nephrolithotomy(PCNL)operation in patients with complex renal calculi,and to predict the positive predictive effet of urinary culture and stone culture in combination with leuko-cytes and nitrites before operation,S0 as to provide early medical decision and basis for urinary sepsis after PCNL operation.Methods From September 2018 to November 2019,72 patients with postopera-tive infectious complications were included in the observation group and 128 patients without postoperative infectious complications were included in the control group.The indexes with difference between groups were selected,and independent risk factors were analyzed by binary logistic regression;the pre-diction efficiency of leukocyte and nitrite was analyzed by ROC curve.Results The positive rate of u-rine culture,MDROS,WBC,nitrite,stone culture and operation time in the observation group were sig-nificantly higher than those in the control group(P<0.05),WBC(OR=2.250,P=0.048),NIT(OR=5.833,P=0.031),stone culture(OR=2.667,P=0.001),and urine culture(OR=5.444,P=0.035)and operation time(OR=8.071,P=0.009)were independent risk factors of uremia.AUC of leukocyte combined with nitrite was 0.939.Conclusions Leukocyte,NIT,positive rate of stone culture,positive rate of urine culture and operation time ate independent risk factors of uremia.The combination of leukocyte and nitrite before operation can predict the positive of urine culture and stone culture.It can provide early medical decision-making and basis for pyemia after PCNL.