微创经皮肾镜碎石术后全身炎症反应综合征的危险因素分析

Analysis of risk factors for systemic inflammatory response syndrome after minimally invasive percutaneous nephrolithotomy

目的 探讨微创经皮肾镜碎石术(PCNL)后发生全身炎症反应综合征(SIRS)的危险影响因素.方法 收集2018年9月至2020年9月在本院泌尿外科和南京鼓楼医院接受PCNL治疗的551例患者的临床资料.将患者分为SIRS组(94例)和非SIRS组(457例),采用x2检验和logistic回归分析确定PCNL术后出现SIRS的相关危险影响因素.结果 共94例患者术后出现SIRS,SIRS发生率为17.1%.合并糖尿病、术前尿常规白细胞阳性、术前尿培养阳性、手术时间≥2 h、术中肾盂尿培养阳性以及术中第一针穿刺引流出脓性尿液与PCNL术后发生SIRS均有相关性(均P<0.05).logistic多因素回归分析表明:手术时间≥2 h、术前尿培养阳性、术中肾盂尿培养阳性和合并糖尿病均是PCNL术后发生SIRS的独立危险因素(均P<0.05).结论 术前存在尿路感染、术中肾盂尿培养阳性、手术时间长和合并糖尿病是PCNL术后发生SIRS的独立危险因素.治疗基础病、减少手术时间和合理使用抗生素能够有效减少术后SIRS发生率.

Objective To investigate the risk factors of systemic inflammatory response syndrome(SIRS)after minimally invasive percutaneous nephrolithotomy(PCNL).Methods The clinical data of 551 patients who underwent PCNL in the department of urology,the second people's hospital of Lianyungang and Nanjing drum tower hospital from September 2018 to September 2020 were collected.The patients were divided into SIRS group(94 cases)and non-SIRS group(457 cases).Chisquare test and logistic regression analysis were used to determine the risk factors of SIRS after PCNL.Results A total of 94 patients developed systemic inflammatory response syndrome after surgery,the incidence was 17.1%.Patients with diabetes,preoperative urine white blood cell positive,preoperative urine culture positive,operation time≥2 h,intraoperative renal pelvic urine culture positive,and intraoperative first needle puncture drainage of purulent urine were significantly different between the two groups(all P<0.05).Logistic multivariate regression analysis revealed that operation time≥2 h,positive urine culture before operation,positive renal pelvic urine culture during operation,and diabetes are independent risk factors for postoperative systemic inflammatory response syndrome(all P<0.05).Conclusionss Preoperative urinary tract infection,positive intraoperative renal pelvic urine culture,long operation time,and diabetes are independent risk factors for postoperative SIRS.Treatment of underlying diseases,reduction of operation time and rational use of antibiotics can effectively reduce the incidence of postoperative SIRS.