结石大小及形态、穿刺通道、尿培养结果与经皮肾镜取石术患者并发尿源性脓毒血症的关系探究

Study on the relationship between the size and shape of stone, puncture channel, urine culture results and urogenic septicopyemia in patients undergoing percutaneous nephrolithotomy

目的 探讨结石大小及形态、穿刺通道、尿培养结果与经皮肾镜取石术(PCNL)患者并发尿源性脓毒血症的关系。方法 回顾性选取2019年4月至2022年2月海南西部中心医院接受PCNL的患者168例,其中并发尿源性脓毒血症的22例患者作为研究组,未并发尿源性脓毒血症的146例患者作为对照组。比较两组患者的一般资料,Logistic回归模型分析并发尿源性脓毒血症的危险因素,分析结石大小及形态、穿刺通道、尿培养结果联合预测并发尿源性脓毒血症的价值。结果 两组患者的性别构成比、年龄、体重指数、职业、合并高血压占比、合并脑血管疾病占比、结石部位、术中失血量比较,差异均无统计学意义(P>0.05);研究组合并高血糖占比、结石大小>3 cm占比、结石形态为鹿角形或铸形的占比、穿刺通道为标准通道的占比、术前尿培养结果阳性占比、术前血清C反应蛋白水平、术前尿白细胞计数均高于对照组,手术时间长于对照组,差异均有统计学意义(P<0.05)。多因素Logistic回归模型校正手术时间后,结石大小、结石形态、穿刺通道大小、术前尿培养结果仍与并发尿源性脓毒血症相关(P<0.05)。结石大小及形态、穿刺通道、尿培养结果联合预测PCNL并发尿源性脓毒血症的特异度、准确度高于结石大小、结石形态、穿刺通道、尿培养单独预测,误诊率低于结石大小、结石形态、穿刺通道、尿培养单独预测(P<0.05)。结论 结石大小及形态、穿刺通道、尿培养结果是PCNL患者并发尿源性脓毒血症的主要相关因素,上述指标联合可为临床评估并发尿源性脓毒血症风险提供参考。

Objective To investigate the relationship between the size and shape of stone,puncture channel,urine culture results and urogenic septicopyemia in patients undergoing percutaneous nephrolithotomy(PCNL).Methods A total of 168 patients who underwent PCNL in Hainan Western Central Hospital from April 2019 to February 2022 were retrospectively selected,including 22 patients with urogenic septicopyemia as the study group and 146 patients without urogenic septicopyemia as the control group.The general data of patients in both groups were compared,the risk factors of complicated urosepsis were analyzed by Logistic regression models.The value of stone size and shape,puncture channel and urine culture results in predicting complicated urosepsis was analyzed.Results There were no statistically significant differences between the two groups in terms of gender composition ratio,age,body mass index,occupation,proportion of concomitant hypertension,proportion of concomitant cerebrovascular disease,location of stones,and intraoperative blood loss(P>0.05);the proportion of hyperglycemia,the proportion of stones with a size greater than 3 cm,the proportion of stones with staghorn or cast shapes,the proportion of puncture channels as standard channels,the proportion of positive preoperative urine culture results,preoperative serum CRP levels,and preoperative urine white blood cell count in the study group were higher than those in the control group,the hand surgery time in the study group was longer than that in the control group,and the differences were statistically significant(P<0.05).After adjusting the operation time by multivariate Logistic regression model,the stone size,stone shape,puncture channel size and preoperative urine culture results were still associated with urogenic septicopyemia(P<0.05).The specificity and accuracy of combined prediction of stone size and shape,puncture channel and urine culture results for PCNL complicated with urosepsis were higher than those of single prediction of stone size,stone shape,puncture channel and urine culture,and the misdiagnosis rate was lower than that of single prediction of stone size,stone shape,puncture channel and urine culture(P<0.05).Conclusion Stone size and shape,puncture channel and urine culture results are the main related factors of PCNL patients complicated with urosepsis.The combination of the above indicators can provide reference for clinical assessment of the risk of complicated with urosepsis.