经皮肾镜配合钬激光碎石术后尿源性脓毒血症的影响因素分析及应对措施

Analysis of influencing factors and countermeasures in patients with urinary sepsis after percutaneous nephroscope with holmium laser lithotripsy

目的探讨经皮肾镜配合钬激光碎石术后尿源性脓毒血症的影响因素,制定应对措施,以降低尿源性脓毒血症发生率。方法选取2018年1月-2020年12月海南西部中心医院200例经皮肾镜配合钬激光碎石术后患者作为研究对象,统计尿源性脓毒血症发生率,并采用单、多因素进行影响因素分析,同时构建Logistic回归模型,明确影响因素对尿源性脓毒血症发生的预测价值。结果200例经皮肾镜配合钬激光碎石术后患者中,尿源性脓毒血症发生率9.50%;Logistic回归分析显示,有慢性肾功能不全、尿培养阳性、微通道、白细胞数>10×10^(9)/L是经皮肾镜配合钬激光碎石术后尿源性脓毒血症的危险因素(P<0.05);根据预测值和真实值绘制ROC曲线,AUC为0.921(95%CI:0.803~0.904),当Logistic(P>0.068)时预测价值最优,预测敏感度为78.95%,特异度为81.22%。结论尿源性脓毒血症是经皮肾镜配合钬激光碎石术后严重并发症,慢性肾功能不全、尿培养阳性、微通道、白细胞数>10×10^(9)/L是其发生的危险因素,对于合并上述因素患者,应当提高警惕,术前充分抗感染,加强围手术期监测,避免尿源性脓毒血症的发生和进展。

Objective To investigate the influencing factors of patients with urinary sepsis after percutaneous nephroscope with holmium laser lithotripsy,and to formulate countermeasures to reduce the incidence of urinary sepsis.Methods From January 2018 to December 2020,200 patients after percutaneous nephroscope combined with holmium laser lithotripsy were selected as the research objects.The incidence of urinary sepsis was counted,and single and multiple factors were used to analyze the influencing factors.At the same time,a Logistic regression model was constructed to clarify the predictive value of influencing factors on the occurrence of urinary sepsis.Results Among 200 patients after percutaneous nephroscope combined with holmium laser lithotripsy,the incidence of urinary sepsis was 9.50%.Logistic regression analysis showed that chronic renal insufficiency,positive urine culture,microchannels,and white blood cell count>10×10^(9)/L were risk factors for urinary sepsis after percutaneous nephroscope combined with holmium laser lithotripsy(P<0.05).The ROC curve was drawn based on the predicted value and the true value.The AUC was 0.921(95%CI:0.803~0.904).When Logistic(P>0.068),the predicted value was the best,the prediction sensitivity was 78.95%,and the specificity was 81.22%.Conclusion Urinary sepsis is a critical complication after percutaneous nephroscope with holmium laser lithotripsy.Chronic renal insufficiency,positive urine culture,microchannels,and white blood cell count>10×10^(9)/L are the risk factors for its occurrence.For patients with the above factors.It is necessary to be vigilant,adequately fight infection before surgery,strengthen perioperative monitoring,and avoid the occurrence and progression of urinary sepsis.