输尿管肾盂镜钬激光碎石术后尿脓毒症相关危险因素分析

Risk factor for urosepsis after transurethral ureterorenoscopic holmium laser lithotripsy

目的探讨经尿道输尿管肾盂镜钬激光碎石术(URSL)后发生尿脓毒症的危险因素。方法回顾性分析2015年6月至2020年12月在北京大学首钢医院行经尿道输尿管肾盂镜钬激光碎石术治疗上尿路结石患者的临床资料,将患者分为术后脓毒症组(21例)和非脓毒症组(1086例),比较2组患者性别、年龄、体质量指数(BMI)、糖尿病、结石分侧、结石大小、CT值、手术时间、术前留置输尿管支架管、术前尿路感染、术前梗阻性肾盂肾炎、术前尿细菌培养、手术方式。分析经尿道输尿管肾盂镜碎石术后感染的危险因素。结果1107例患者纳入研究,其中21例患者(21/1107)符合尿脓毒症诊断标准。与非脓毒症组比较,脓毒症组患者在BMI、结石大小、手术时间、术前梗阻性肾盂肾炎、术前尿细菌培养及手术方式差异有统计学意义(P均<0.05)。多因素Logistic回归分析显示手术时间、术前梗阻性肾盂肾炎、术前尿细菌培养阳性是术后发生尿脓毒症的相关危险因素(OR=1.157,95%CI:1.026~1.305,P=0.018;OR=4.733,95%CI:1.274~17.573,P=0.020;OR=5.287,95%CI:1.408~19.857,P=0.014)。结论对于术前上尿路结石引起梗阻性肾盂肾炎和尿细菌培养阳性,及手术时间较长的患者,应警惕URSL术后发生尿脓毒症的风险。

Objective To identify the risk factors for urinary sepsis after transurethral ureteropyeloscopic holmium laser lithotripsy(URSL).Methods Clinical data of patients with upper urinary calculi treated by URSL at Peking University Shougang Hospital from June 2015 to December 2020 were retrospectively analyzed,and the patients were divided into either a postoperative sepsis group(21 cases)or a non-sepsis group(1086 cases)according to the development of postoperative sepsis or not.Gender,age,body mass index(BMI),diabetes,calculus location,calculus size,CT value,operation time,preoperative indwelling of ureteral stents,preoperative urinary tract infection,preoperative obstructive pyelonephritis,preoperative urine bacterial culture,and surgical methods were compared between the two groups to identify the risk factors for urosepsis after URSL.Results A total of 1107 patients were enrolled,of whom 21(21/1107)met the diagnostic criteria for urinary sepsis.Compared with the non-sepsis group,there were statistically significant differences in BMI,stone size,operation time,preoperative obstructive pyelonephritis,preoperative urine bacterial culture,and surgical methods in the sepsis group(P<0.05).Multivariate Logistic regression analysis showed that operative time,preoperative obstructive pyelonephritis,and positive preoperative urine bacterial culture were risk factors for postoperative urinary sepsis(OR=1.157,95%CI:1.026~1.305,P=0.018;OR=4.733,95%CI:1.274~17.573,P=0.020;OR=5.287,95%CI:1.408~19.857,P=0.014).Conclusion For patients with obstructive pyelonephritis and positive urine bacterial culture caused by upper urinary calculi before surgery,and patients with long operation time,we should be alert to the risk of urinary sepsis after URSL.