经尿道输尿管镜钬激光碎石术后尿路感染的影响因素及其对患者细胞免疫功能和生活质量的影响

Influence Factors of Urinary Tract Infection after Transurethral Ureteroscopic Holmium Laser Lithotripsy and Their Effects on Cellular Immune Function and Quality of Life

目的:探讨经尿道输尿管镜钬激光碎石术后尿路感染的影响因素及其对患者细胞免疫功能和生活质量的影响。方法:选择2019年6月-2021年1月期间来我院接受经尿道输尿管镜钬激光碎石术治疗的150例患者。采用流式细胞仪检测T淋巴细胞亚群指标:CD4^(+)、CD8^(+),计算CD4^(+)/CD8^(+)。手术前后采用生活健康量表简表(SF-36)评价患者生活质量。分析经尿道输尿管镜钬激光碎石术后尿路感染的影响因素。结果:150例患者中,术后有18例发生尿路感染,发生率为12.00%(18/150)。根据是否发生尿路感染分为感染组(n=18)和未感染组(n=132)。单因素分析结果显示,经尿道输尿管镜钬激光碎石术后尿路感染与结石直径、年龄、合并糖尿病、住院时间、预防性应用抗菌药物、结石残留情况、手术时间、双J管留置时间有关(P<0.05)。多因素Logistic回归分析结果显示:年龄为61~岁、结石直径≧2 cm、手术时间≧2 h、合并糖尿病、双J管留置时间≧14 d、有结石残留是术后发生尿路感染的危险因素,而预防性应用抗菌药物是其保护因素(P<0.05)。两组术后CD4^(+)、CD4^(+)/CD8^(+)下降,但未感染组高于感染组;CD8^(+)升高,但未感染组低于感染组(P<0.05)。两组术后精神健康、总体健康、社会功能、情感职能、活力、躯体疼痛、生理职能、生理功能评分均升高,且未感染组高于感染组(P<0.05)。结论:经尿道输尿管镜钬激光碎石术后尿路感染患者细胞免疫功能下降,生活质量降低,且其尿路感染受年龄、结石直径、手术时间等因素影响,预防性应用抗菌药物可降低尿路感染的发生风险。

Objective:To investigate the influence factors of urinary tract infection after transurethral ureteroscopic holmium laser lithotripsy and their effects on cellular immune function and quality of life.Methods:150 patients who received transurethral ureteroscopic holmium laser lithotripsy in our hospital from June 2019 to January 2021 were selected.T lymphocyte subsets were detected by flow cytometry:CD4^(+)and CD8^(+),CD4^(+)/CD8^(+)were calculated.The quality of life of the patients was evaluated by 36-item short form of life health scale(SF-36)before and after operation.Urinary tract infection after transurethral holmium laser lithotripsy were analyzed.Results:Among the 150 patients,18 had urinary tract infection after operation,and the incidence was 12.00%(18/150).According to whether there was urinary tract infection,they were divided into infected group(n=18)and uninfected group(n=132).Univariate analysis showed that urinary tract infection after urethra holmium laser lithotripsy were related to stone diameter,age,diabetes mellitus,length of stay,prophylactic use of antibiotics,residual stones,operation time,and double J tube indwelling time(P<0.05).The results of multivariate Logistic regression analysis showed that:age 61~years,stones diameter≧2 cm,double J catheter indwelling time≧14 d,operation time≧2 h,with residual stones,complicated with diabetes mellitus were risk factors for postoperative urinary tract infection,and preventive application of antibiotics was a protective factor(P<0.05).CD4^(+)and CD4^(+)/CD8^(+)decreased in the two groups after operation,but the uninfected group was higher than the infected group.CD8^(+)increased,but the uninfected group was lower than the infected group(P<0.05).The scores of mental health,general health,social function,emotional function,vitality,physical pain,physiological function,physiological function increased in the two groups,and the uninfected group was higher than the infected group(P<0.05).Conclusion:After transurethral ureteroscopic holmium laser lithotripsy,the cellular immune function and quality of life of patients with urinary tract infection decrease,and their urinary tract infection is affected by age,stone diameter,operation time and other factors.The preventive application of antibiotics can reduce the risk of urinary tract infection.