复杂性肾结石输尿管软镜碎石术后并发SIRS风险模型的构建及其护理措施

Construction and Nursing Measures of a Risk Model for Concurrent Sirs after Ureteroscopic Lithotripsy for Complex Kidney Stones

目的:探讨复杂性肾结石输尿管软镜碎石术后并发全身炎症反应综合征(SIRS)风险模型的构建及其护理措施。方法:选取2021年1月—2023年12月南华大学附属第二医院收治的397例行输尿管软镜碎石术复杂性肾结石患者作为研究对象,SIRS组为术后并发SIRS患者(n=37),无SIRS组为术后无并发SIRS患者(n=360)。记录术后并发SIRS发生率,并就可能影响SIRS发生的各因素进行单因素及多因素回归分析,构建其预测模型,并对该预测模型的临床应用价值进行验证分析及采取针对性护理措施。结果:行输尿管软镜碎石术治疗的复杂性肾结石患者397例,术后并发SIRS患者37例,SIRS发生率为9.32%。对可能影响患者SIRS发生的各因素进行单因素分析,结果显示,两组年龄、体质量指数、吸烟史、饮酒史、结石位置和合并高血压比较,差异无统计学意义(P>0.05);SIRS组女性占比高于无SIRS组,结石>5 cm占比高于无SIRS组,感染性结石占比高于无SIRS组,积水中重度占比高于无SIRS组,合并糖尿病占比高于无SIRS组,手术时间≥120 min占比高于无SIRS组,术中高压灌注冲洗占比高于无SIRS组,术后引流不畅占比高于无SIRS组,差异有统计学意义(P<0.05)。多因素logistic回归分析,结果显示,女性、结石>5 cm、感染性结石、积水中重度、合并糖尿病、手术时间≥120 min、术中高压灌注冲洗以及术后引流不畅进入回归模型,为影响SIRS发生的独立危险因素。对上述患者进行预测模型P值计算,并采用ROC曲线验证上述模型对SIRS发生预测价值,结果显示,曲线下面积为0.902,灵敏度81.10%,特异度94.00%。结论:性别、结石大小、感染性结石、积水程度、合并糖尿病、手术时间、术中高压灌注冲洗以及术后引流不畅是影响杂性肾结石输尿管软镜碎石术后并发SIRS的重要因素,根据上述因素拟定相应的风险预测模型,且该模型预测效果良好,值得进一步深入分析。

Objective:To explore the construction of a risk model for concurrent System Inflammatory Reaction Syndrome(SIRS)after ureteroscopic lithotripsy for complex kidney stones and its nursing measures.Method:A total of 397 patients with complex kidney stones who underwent ureteroscopic lithotripsy in the hospital from January 2021 to December 2023 were selected.The incidence of postoperative complications of SIRS was recorded,and univariate and multivariate regression analyses were conducted on various factors that may affect the occurrence of SIRS.A predictive model was constructed,and its clinical application value was verified and analyzed.And take targeted nursing measures for it.Result:397 patients with complex kidney stones treated by ureteroscopic lithotripsy,37 patients were complicated by SIRS after operation,the incidence of SIRS was 9.32%.Univariate analysis of the factors that may affect the occurrence of SIRS showed that there was no significant difference in age,body mass index,smoking history,drinking history,stone location and combined hypertension between the two groups(P>0.05).The proportion of women in SIRS group was higher than that in no SIRS group.The proportion of stones>5 cm,which was higher than that in no SIRS group.The proportion of infectious stones was higher than that in no SIRS group.The proportion of moderate and severe hydrops was higher than that in no SIRS group.The proportion of diabetes mellitus was higher than that in no SIRS group,and the proportion of operation time≥120 min,which was higher than that in no SIRS group.The proportion of intraoperative high pressure perfusion irrigation was higher than that of non-SIRS group,and the proportion of postoperative poor drainage was higher than that of non-SIRS group,the difference was statistically significant(P<0.05).Multivariate logistic regression analysis showed that female,calculi>5 cm,infectious calculi,moderate to severe hydrops,complicated diabetes mellitus,operation time≥120 min,intraoperative high-pressure perfusion irrigation and postoperative poor drainage entered the regression model,and were independent risk factors affecting the occurrence of SIRS.The P value of the prediction model was calculated for the above patients,and the ROC curve was used to verify the prediction value of the above model for the occurrence of SIRS.The results showed that the area under the curve was 0.902,the sensitivity was 81.10%,and the specificity was 94.00%.Conclusion:Sex,stone size,infectious stones,degree of hydronephrosis,diabetes,operation time,intraoperative high-pressure perfusion and irrigation,and postoperative poor drainage are important factors that affect the SIRS after ureteroscopic lithotripsy for complex renal stones.According to the above factors,the corresponding risk prediction model is developed,and the model has good prediction effect,which is worth further in-depth analysis.