术前血糖水平对糖尿病患者行输尿管软镜碎石术后发生感染相关并发症的影响

Effect of preoperative glycemic level on infection-related complications of diabetic patients after flexible ureteroscopic lithotripsy

目的:观察2型糖尿病(T2DM)患者行输尿管软镜碎石术(FURL)后出现感染相关并发症的影响因素,探讨T2DM患者术前血糖水平与发生术后感染相关并发症的关系,为T2DM患者在接受FULR术后发生感染相关并发症的早期预防及治疗提供参考。方法:选择接受FURL手术治疗的83例上尿路结石并发T2DM患者进行回顾性分析,根据术后是否发生感染将其分为感染组和非感染组,对比2组患者的临床资料,单因素和多因素Logistic回归分析筛选出发生术后感染的独立影响因素,受试者工作特征(ROC)曲线界定术前血糖控制良好的水平,据此将患者分为血糖控制良好组(血糖水平≤7.7 mmol·L^(-1))和血糖控制不佳组(血糖水平>7.7 mmol·L^(-1)),比较2组T2DM患者术后感染相关并发症发生频数和平均术后住院天数。结果:单因素Logistic回归分析,术前血糖水平、结石直径≥2 cm、术前尿常规白细胞计数>10/HP、术前尿培养阳性和手术时间≥90 min为T2DM患者术后感染事件的可能影响因素;二元多因素Logistic回归分析,术前血糖水平、手术时间≥90 min、结石直径≥2 cm和术前尿培养阳性为T2DM患者术后出现感染相关并发症的独立影响因素。ROC曲线分析,以术前血糖7.7 mmol·L^(-1)作为截断值时,预测患者术后感染相关事件的灵敏度为70.37%,特异度为96.43%。血糖控制良好组患者术后感染相关并发症发生频数和术后平均住院天数均低于血糖控制不佳组(P<0.05)。结论:术前血糖水平、术前尿培养阳性、手术时间≥90 min和结石直径≥2 cm是T2DM患者行FURL术后发生感染并发症的独立影响因素。以术前血糖水平≤7.7 mmol·L^(-1)作为血糖控制良好的标准,能够有效降低患者的术后感染率,缩短术后住院时间。

Objective:To observe the influencing factors of infection-related complications of the patients with type 2 diabetes mellitus(T2DM)after flexible ureteroscopic lithotripsy(FURL),and to explore the relationship between the preoperative glycemic level and postoperative infection-related complications of the T2DM patients,and to provide the basis for the early prevention and treatment of infection-related complications of the T2MD patients after FULR.Methods:A total of 83 patients diagnosed as urolithiasis with concurrent T2DM and received FURL were retrospectively analyzed.They were divided into infection group and non-infection group according to whether or not infection occurred after surgery.Univariate and multivariate Logistic regression analysis were used to examine the independent risk factors for the postoperative infections.Receiver operating characteristic(ROC)curve was used to define the well-controlled level of preoperative glycemic;based on the optimal cut-off value,the patients were divided into good glycemic control group(glycemic level≤7.7 mmol·L^(-1))and poor glycemic control group(glycemic level>7.7 mmol·L^(-1)).The incidence frequency of postoperative infection-related complications and avarage postoperative hospital stay of the patients in two groups were compared.Results:The univariate Logistic regression analysis results showed that the preoperative glycemic level,the stone diameter≥2 cm,preoperative urine routine leukocyte count≥10/HP,the positive preoperative urine culture,and the operation time≥90 min were the independent influencing factors for the postoperative infection-related complications of the T2DM patients.The multivariate Logistic regression analysis reesults showed that the preoperative glycemic level,the operation time≥90 min,the stone diameter≥2 cm,and positive preoperative urine culture were the independent influencing factors for the postoperative infection-related complications of the T2DM patients.The ROC curve analysis results showed that if the optimal cut-off value of the preoperative glycemic level was 7.7 mmol·L^(-1),the sensitivity to predict the postoperative infection-related events of the patients was 70.37%,and the specificity was 96.43%.The incidence frequency of postoperative infection-related complications and the average postoperative hospital stay of the patients in good glycemic control group were lower than those in poor glycemic control group(P<0.05).Conclusion:The preoperative glycemic level,positive preoperative urine culture,operative time≥90 min and stone diameter≥2 cm are the independent influencing factors for the infection-related complications of the T2DM patients after FURL.When the preoperative glycemic level≤7.7 mmol·L^(-1) is used as the standard for good glycemic control,the incidence of postoperative infection can be effectively reduced and the postoperative hospital stay can be shortened.