上尿路结石患者输尿管软镜碎石取石术后并发尿脓毒血症的危险因素分析

Risk factors of urinary sepsis in patients with upper urinary calculi after flexible ureteroscopic lithotripsy

目的探讨上尿路结石患者输尿管软镜碎石取石(FURL)术后并发尿脓毒血症的危险因素。方法抽取2015年5月至2020年5月克拉玛依市人民医院收治的68例行FURL治疗的上尿路结石患者为研究对象,所有患者术后随访1周,统计患者尿脓毒症发生情况并根据是否并发尿脓毒症将患者分为发生组与未发生组。比较两组患者临床资料,经单因素、多因素分析上尿路结石患者FURL术后并发尿脓毒血症的危险因素。结果纳入的68例行FURL的上尿路结石患者中,术后8例发生尿脓毒症(纳入并发组),发生率为11.76%;60例未发生尿脓毒症患者纳入未发生组。两组年龄、性别、尿路手术史、肾积水比较,差异未见统计学意义(P>0.05);两组结石直径、合并糖尿病、降钙素原(PCT)、内毒素(EXT)、白细胞介素-6(IL-6)、C-反应蛋白(CRP)水平比较,差异有统计学意义(P<0.05)。经Logistic回归分析显示,结石直径≥2 cm,合并糖尿病,血清PCT、EXT、IL-6、CRP高表达是上尿路结石患者FURL术后发生尿脓毒血症的影响因素(OR>1,P<0.05)。结论上尿路结石患者FURL术后尿脓毒血症发生风险较高,结石直径≥2 cm,合并糖尿病,血清PCT、EXT、IL-6、CRP高表达是上尿路结石患者FURL术后发生尿脓毒血症危险因素。

Objective To investigate the incidence and influencing factors of urinary sepsis in patients with upper urinary calculi after flexible ureteroscopic lithotripsy(FURL).Methods Sixty-eight patients with upper urinary tract calculi treated with FURL in Karamay People’s Hospital from May 2015 to May 2020 were selected as the research object.All patients were followed up for 1 week after operation,and the incidence of urinary sepsis was analyzed.According to whether the patients complicated with urinary sepsis,the patients were divided into the occurrence group and non-occurrence group.The clinical data of two groups were compared.The risk factors of urinary sepsis in patients with upper urinary calculi after furl operation were analyzed by univariate and multivariate analysis.Results Of the 68 patients with upper urinary calculi who underwent FURL,8 patients of urinary sepsis after operation(included into the occurrence group),with an incidence of 11.76%;while 60 patients who did not complicated with urinary sepsis after operation were included into the non-occurrence group.There was no significant difference in age,gender,history of urinary surgery and hydronephrosis between the two groups(P>0.05);there was significant difference in stone diameter,diabetes mellitus,procalcitonin(PCT),endotoxin(EXT),interleukin-6(IL-6)and C-reactive protein(CRP)levels between the two groups(P<0.05).Logistic regression analysis showed that stone diameter≥2 cm,diabetes mellitus,high expression of serum PCT,EXT,IL-6 and CRP were the influencing factors of urinary sepsis after FURL(OR>1,P<0.05).Conclusions The risk of urinary sepsis in patients with upper urinary calculi after FURL operation is high.Stone diameter≥2 cm,diabetes mellitus,high expression of serum PCT,EXT,IL-6 and CRP are the risk factors of urinary sepsis in patients with upper urinary calculi after FURL operation.