上尿路结石微创治疗术后发热相关因素分析
摘要
目的探讨上尿路结石微创术后发热的相关因素及临床意义。方法回顾性分析本院2016年7月至2017年11月收治的100例上尿路结石患者的临床资料。男78例,女22例。年龄21～74(48. 7±12. 4)岁,结石面积376. 8～2 245. 1(中位数1 031. 65) mm2。依据结石具体情况行经皮肾镜碎石取石术(PCNL)或(和)输尿管镜碎石取石术(URL)。对围手术期可能导致术后发热的因素进行单因素和多因素logistic回归分析。结果本组术后发热共21例(21%)。单因素分析结果显示,发热组与未发热组性别、术前尿白细胞阳性、术前亚硝酸盐阳性、术中肾盂尿液培养阳性、手术时间、结石直径及结石面积、结石成分和术中出血量组间差异均有统计学意义(P <0. 05);而年龄,合并糖尿病、高血压,既往体外冲击波碎石术(ESWL)、URL及PCNL,术中通道数目,术前尿培养阳性、积水程度组间差异无统计学意义(P> 0. 05)。多因素logistic分析显示,结石培养阳性、术中出血量> 400 ml为术后发热的独立危险因素(P <0. 05)。结论术中出血量> 400 ml及感染性结石(结石培养阳性)是上尿路结石微创治疗术后患者发热的危险因素。围手术期密切关注术中出血量、结石培养及药敏结果,即时干预可降低术后SIRS及尿源性脓毒血症发生率,提高手术安全性。
引文
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[13]陈亮,李建兴.经皮肾镜碎石取石术的并发症的防治[J].现代泌尿外科杂志,2013,18(6):527-531.
[14] Garbens A,CJD W,Bjarnason G,et al. Platelet to white blood cell ratio predicts 30-day postoperative infectious complications in patients undergoing radical nephrectomy for renal malignancy[J].Can Urol Assoc J,2017,11(11):E414-E420. DOI:10. 5489/cuaj. 4478.
[15]安立哲,黄晓波,许清泉,等.经皮肾镜碎石取石术后发生全身炎症反应综合征的多因素分析[J].中国微创外科杂志,2017,17(11):965-969.
[2]曹洪豪.上尿路结石、肾盂尿和中段尿细菌培养和药敏实验对感染性结石的诊断价值[J].贵阳医学院学报,2014,39(6):921-922,925.
[3]席启林,欧阳骏,侯建全,等.输尿管镜钬激光碎石术治疗输尿管结石术后发热相关因素分析[J].临床泌尿外科杂志,2015,30(6):518-520.
[4]吴海洋.上尿路腔内碎石术致急性感染性休克的早期预警研究[D].杭州:浙江大学,2012.
[5] Korets R,Graversen JA,Kates M,et al. Post-percutaneous nephrolithotomy systemic inflammatory response:a prospective analysis of preoperative urine,renal pelvic urine and stone cultures[J]. J Urol,2011,186(5):1899-1903. DOI:10. 1016/j. juro. 2011. 06. 064.
[6] Kumar S,Bag S,Ganesamoni R,et al. Risk factors for urosepsis following percutaneous nephrolithotomy:role of 1 week of nitrofurantoin in reducing the risk of urosepsis[J]. Urol Res,2012,40(1):79-86. DOI:10. 1007/s00240-011-0386-6.
[7] Koras O,Bozkurt IH,Yonguc T,et al. Risk factors for postoperative infectious complications following percutaneous nephrolithotomy:a prospective clinical study[J]. Urolithiasis,2015,43(1):55-60. DOI:10. 1007/s00240-014-0730-8.
[8]郑晓秋,王万东,张继承,等.尿路结石和尿路感染的关系分析[J].中国现代医学杂志,2015,25(7):92-95.
[9] Dogan HS,Guliyev F,Cetinkaya YS,et al. Importance of microbiological evaluation in management of infectious complications following percutaneous nephrolithotomy[J]. I nt Urol Nephrol,2007,39(3):737-742. DOI:10. 1007/s11255-006-9147-9.
[10] Shoshany O,Margel D,Finz C,et al. Percutaneous nephrolithotomy for infection stones:what is the risk for postoperative sepsis?A retrospective cohort study[J]. Urolithiasis,2015,43(3):237-242. DOI:10. 1007/s00240-014-0747-z.
[11]范钧泓,吴文起,朱玮,等.经皮肾镜取石术后全身炎症反应综合征的相关危险因素分析[J].中华泌尿外科杂志,2017,38(11):857-861. DOI:10. 3760/cma. j. issn. 1000-6702. 2017.11. 013.
[12]赵炜.泌尿系结石腔内碎石术后并发感染性休克的危险因素分析[J].中国医师杂志,2016,18增刊:115-116. DOI:10.3760/cma. j. issn. 1008-1372. 2016. z1. 049.
[13]陈亮,李建兴.经皮肾镜碎石取石术的并发症的防治[J].现代泌尿外科杂志,2013,18(6):527-531.
[14] Garbens A,CJD W,Bjarnason G,et al. Platelet to white blood cell ratio predicts 30-day postoperative infectious complications in patients undergoing radical nephrectomy for renal malignancy[J].Can Urol Assoc J,2017,11(11):E414-E420. DOI:10. 5489/cuaj. 4478.
[15]安立哲,黄晓波,许清泉,等.经皮肾镜碎石取石术后发生全身炎症反应综合征的多因素分析[J].中国微创外科杂志,2017,17(11):965-969.
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