输尿管软镜术后尿源性脓毒血症的治疗及危险因素分析

Treatment and risk factors of urosepsis after flexible ureteroscopic

目的探讨输尿管软镜钬激光碎石术后尿源性脓毒血症的治疗,分析其危险因素。方法回顾2019年1月至2021年3月在我院泌尿外科行输尿管软镜下钬激光碎石治疗154例患者的临床资料,发现术后发生尿源性脓毒血症19例。对比135例对照组及19例尿源性脓毒血症组手术前后临床常规检测指标,用Logistic回归分析方法评价其危险因素。结果年龄>60岁、尿培养阳性、手术时间>90 min、结石直径≥20 mm是发生尿源性脓毒血症的危险因素(P<0.05);多因素Logistic回归分析得出年龄>60岁、结石直径≥20 mm为尿源性脓毒血症的独立危险因素。结论输尿管软镜下钬激光碎石术并发尿源性脓毒血症,应尽早使用强效抗生素抗感染同时早期复苏,恢复器官灌注,可有效提高抢救成功率;年龄>60岁、结石直径≥20 mm、尿培养阳性为输尿管软镜术后并发尿源性脓毒血症的高危因素。

Objective To investigate the treatment and risk factors of urosepsis after flexible ureteroscopic.Methods A total of 154 patients with urosepsis treated by Holmium laser lithotripsy operation under flexible ureteroscopic were retrospectively analyzed from January,2019 to March,2021 in department of Urinary Surgery of the Affiliated Hospital of Zunyi Medical University,in which 19 cases with postoperative concurrent urosepsis occurred.A total of 135 cases without postoperative concurrent urosepsis was collected as the control group.Multi-factor logistic regression analysis was carried out on assessment of risk factors of postoperative concurrent occurrence.Results(1)Single factor analysis:cases of age>60 years old,positive urine culture,operation time and the renal calculi diameter≥20 mm were risk factors to the urinary-origin urosepsis;(2)Multi-factor logistic regression analysis:cases of age>60 years old and the renal calculi diameter≥20 mm were independent risk factors to the urinary-origin urosepsis.Conclusion(1)The concurrent urosepsis after Holmium laser lithotripsy operation under flexible ureteroscopic should be diagnosed as early as possible and treated with powerful antibiotics for anti-infection at the same time for early recovery of organ perfusion,which might effectively improve the rescue success rate;(2)Cases of age>60 years old,the renal calculi diameter≥20 mm and positive urine culture are high risk factors to the occurrence of concurrent urosepsis after flexible ureteroscopic.