上尿路腔内碎石术后并发尿源性脓毒症休克的处理和预防

目的 探讨上尿路腔内碎石术后并发尿源性脓毒症休克的原因和防治措施.方法 回顾性分析2005年1月至2014年5月上尿路腔内碎石术后12例尿源性脓毒症休克患者的临床资料.其中经皮肾镜（PCNL）治疗者9例,经尿道输尿管镜（URL）治疗者3例,均表现为术后3～16h内出现高热（T＞39.0℃）,血压降至90/60mmHg以下,心率＞110次/分.根据临床表现均诊断为尿源性脓毒症休克.12例均给予抗休克和抗感染等治疗.结果 其中10例患者在72 ～ 120 h后逐渐停用升压药物,2周内体温和血常规恢复正常,最后治愈出院.2例患者因出现多脏器功能障碍综合症（MODS）而于术后第2、3天抢救无效死亡。结论 尿源性脓毒症休克是上尿路腔内碎石术后严重并发症之一,早期发现及合理处理是治疗成功的关键,加强预防措施可降低术后重症感染的发生率。

Management and Prevention of Uroseptic Shock after Endoscopic Lithotripsy for Upper Urinary Tract Stones

Objective To explore the etiology, management and prevention of uroseptic shock after endoscopic lithotripsy for upper urinary tract stones. Methods The clinical data were retrospective analyzed which collected from 12 patients （2 men, 10 women ） with uroseptic shock after endoscopic lithotripsy for upper urinary tract stones from January 2005 to May 2014. Their age ranged from 37 to 68 years with a mean of 50 years. 9 patients were treated with PCNL, and 3 patients were treated with rigid ureteroscopic lithotripsy. The patients were characterized by a temperature over 39 ℃ , a blood pressure below 90/60 mmHg and a heart rate over 110 BPM within 3-16 hours after the operation. All patients were diagnosed with uroseptic shock according to the clinical manifestation. All patients underwent anti-shock and anti-infection therapies rapidly. Results 10 patients were cured in the end. The vasopressors were gradually stopped within 72-120 hours, and patients＇ temperature and blood routine tests returned to normal within 2 weeks. 2 patients died of multiple organ dysfunction syndrome （MODS） after 2 or 3 days of operation. Conclusion Uroseptic shock is one of serious complications after endoscopic lithotripsy for upper urinary tract stones. The improvement in the prevention can effectively prevent the post-operation severe infections. The key to the successful treatment depends on early diagnosis and proper treatment.