复杂性肾结石输尿管软镜碎石术后发生全身炎症反应综合征的危险因素分析

Risk factors of systemic inflammatory response syndrome after flexible ureteroscopy for complex kidney stones

目的观察复杂性肾结石患者采用输尿管软镜碎石术(flexible ureteroscopy lithotripsy, fURL)治疗后全身炎症反应综合征(systemic inflammatory response syndrome, SIRS)的发生情况,探讨复杂性肾结石患者fURL术后发生SIRS的危险因素。方法 278例复杂性肾结石患者均采用fURL治疗,根据术后是否发生SIRS分为对照组248例和SIRS组30例,比较2组临床资料;采用多因素logistic回归分析影响复杂性肾结石患者fURL术后发生SIRS的危险因素。结果 278例复杂性肾结石患者fURL术后发生SIRS 30例,发生率为10.8%。SIRS组患者术前血白细胞计数[(6.96±1.85)×10^(9)/L]及白蛋白/球蛋白比值<1.184(33.3%)、术前系统性炎症反应指数(systemic inflammatoryresponse index, SIRI)≥0.726(83.3%)、尿白细胞阳性(73.3%)、尿培养阳性(30.0%)、术前发热(26.7%)和软镜术中未应用负压技术者(93.3%)比率高于对照组[(6.01±1.84)×10^(9)/L、12.1%、53.2%、43.1%、8.1%、6.5%、68.1%](P<0.05)。SIRI≥0.726(OR=3.452,95%CI:1.097~10.862,P=0.034)、术前置入D-J管(OR=3.666,95%CI:1.149~11.698,P=0.028)及术中未应用负压技术(OR=5.474,95%CI:1.160~25.835,P=0.032)是复杂性肾结石患者fURL术后发生SIRS的危险因素。结论术前高SIRI(≥0.726)、术前置入D-J管及术中未使用负压技术是复杂性肾结石患者fURL术后发生SIRS的独立预测因素。

Objective To observe the occurance of systemic inflammatory response syndrome(SIRS) after flexible ureteroscopic lithotripsy(fURL) in patients with complex kidney stones, and to investigate the risk factors of SIRS after fURL. Methods A total of 278 patients receiving fURL procedures for complex renal calculi were divided into non-SIRS group(n=248) and SIRS group(n=30) according to whether postoperative SIRS occurred. The clinical data were compared between two groups. Multivariate logistic regression was used to analyze the risk factors of SIRS after fURL. Results SIRS occurred in 30 patients out of 278 patients(10.8%). The preoperative serum white blood cell count((6.96±1.85)×10^(9)/L), and the proportion of albumin/globulin ratio <1.184(33.3%), systemic inflammatory response index(SIRI) ≥0.726(83.3%), positive urine leucocyte(73.3%), positive urine culture(30.0%), pre-operative fever(26.7%), and no application of negative pressure technique(93.3%) during fURL in SIRS group were higher than those in non-SIRS group((6.01±1.84)×10^(9)/L, 12.1%,53.2%, 43.1%, 8.1%, 6.5%, 68.1%)(P<0.05). SIRI ≥0.726(OR=3.452, 95%CI: 1.097-10.862, P=0.034), preoperative D-J tube indwelling(OR=3.666, 95%CI: 1.149-11.698, P=0.028) and intraoperative no-application of negative pressure technique(OR=5.474, 95%CI: 1.16-25.835, P=0.032) were the risk factors of SIRS after fURL for complex kidney stones. Conclusion Pre-operative elevated SIRI(≥0.726), preoperative D-J tube indwelling and intraoperative no-application of negative pressure technique are the independent predictors of SIRS after fURL for complex kidney stones.