术前尿培养阴性患者微创经皮肾镜碎石取石术后发生尿脓毒症的危险因素

Risk factors of urinary sepsis after mPCNL in patients with negative preoperative urine culture

目的探讨术前尿培养阴性患者微创经皮肾镜碎石取石术(mPCNL)后发生尿脓毒症的危险因素。方法回顾性分析2016年1月-2021年6月于广州中医药大学顺德医院泌尿外科行mPCNL治疗的274例术前尿培养阴性的肾结石患者资料,并观察术后尿脓毒症发生情况,采用logistic回归模型分析mPCNL术后尿脓毒症发生的危险因素。结果术前尿培养阴性患者mPCNL术后11例(4.01%)发生尿脓毒症。单因素分析显示,两组患者的性别分布、BMI、结石负荷、糖尿病百分率、尿WBC≥2+百分率、尿亚硝酸盐阳性百分率、降钙素原、手术时间比较差异有统计学意义。多因素logistic回归分析显示,糖尿病(OR=2.34,95%CI=1.051~5.43,P=0.037)、结石负荷≥1600 mm^(2)(OR=7.51,95%CI:3.17~7.38,P=0.045)、尿亚硝酸盐阳性(OR=6.45,95%CI:0.93~26.87,P=0.028)、尿白细胞≥2+(OR=4.57,95%CI:6.75~11.38,P=0.032)和手术时间≥120 min(OR=3.53,95%CI:1.41~8.85,P=0.042)是术前尿培养阴性患者mPCNL术后发生尿脓毒症的危险因素。结论糖尿病史、结石负荷大、尿白细胞≥2+、尿亚硝酸盐阳性和手术时间≥120 min是术前尿培养阴性患者mPCNL术后发生尿脓毒症的危险因素。

Objective To determine the risk factors of urinary sepsis secondary to minimally invasive percutaneous nephrolithotomy(mPCNL)in patients with negative preoperative urine culture(UC).Methods A total of 274 patients with negative preoperative UC treated with mPCNL during Jan.2016 and Jun.2021 were retrospectively analyzed.The incidence of urinary sepsis was observed,and the general data of patients with or without urinary sepsis after mPCNL were compared.logistic regression model was used to analyze the risk factors of urinary sepsis after mPCNL.Results Urinary sepsis occurred in 11 cases(4.01%).Univariate analysis showed that urinary sepsis was associated with gender,body mass index,stone load,diabetes,urine WBC≥2+,urinary nitrite,procalcitonin,and operation time.Multivariate logistic regression analysis showed that the independent risk factors of urinary sepsis after mPCNL included diabetes(OR=2.34,95%CI=1.051-5.43,P=0.037),stone load(OR=7.51,95%CI=3.17-7.38,P=0.045),urine WBC≥2+(OR=4.57,95%CI=6.75-11.38,P=0.032),urinary nitrite positive(OR=6.45,95%CI=0.93-26.87,P=0.028)and operation time≥120 min(OR=3.53,95%CI=1.41-8.85,P=0.042).Conclusion Diabetes,stone load,urinary WBC≥2+,positive urinary nitrite and operation time≥120 minutes are the risk factors of urinary sepsis after mPCNL in patients with negative urine culture.