经皮肾镜致尿源性脓毒血症的危险因素及最佳干预时机的初步探讨

目的探讨经皮肾镜碎石取石术（PCNL）所致尿脓毒血症的危险因素，及脓毒血症最佳干预时机。 方法回顾性分析2016年1月至2020年2月在郁南县人民医院及南方医科大学第三附属医院进行PCNL治疗的497例患者临床资料，利用Fisher精确检验和二元Logistic回归分析尿脓毒血症相关危险因素，构建预测模型，通过ROC曲线验证该模型的预测效能。 结果在这497例行PCNL术的患者中19例发生尿源性脓毒血症（3.82%）；Fisher精确检验和二元logistic回归分析显示女性、术前尿培养阳性、结石直径>2.5 cm，手术时间>90 min、术者经验（<100例）、合并糖尿病为PCNL术后脓毒血症的独立危险因素。ROC曲线分析显示这些危险因素可以很好的预测尿脓毒血症的发生（AUC=0.926）。在这19例患者中，8例出现感染性休克（42.1%），3例死亡（15.8%）。其中12例早期应用亚胺培南抗感染只有1例进展为感染性休克阶段，余7例则均进展为感染性休克，其中3例死亡。 结论女性、术前尿培养阳性、结石直径>2.5 cm、手术时间>90 min、术者经验<100例、合并糖尿病为PCNL术后尿脓毒血症的危险因素，且这些危险因素对PCNL所致尿脓毒血症具有良好预测效率。早期应用广谱抗生素是降低尿脓毒血症风险的有效方案。

Risk factors of urogenic sepsis induced by percutaneous nephrolithotripsy and optimal time of intervention

ObjectiveTo investigate the risk factors of urinary sepsis caused by percutaneous nephrolithotripsy (PCNL) and the optimal time of intervention. MethodsThe data of 497 patients treated with PCNL in the Third Affiliated Hospital of Southern Medical University and Yunan People's Hospital from January 2016 to February 2020 were analyzed retrospectively. The risk factors related to urinary sepsis were analyzed by Fisher's exact test and multivariate logistic regression analysis, the predictive model of urinary sepsis was established based on these risk factors, and the prediction efficiency of this model was verified by ROC. ResultsThe incidence of urinary sepsis was 3.8% in 497 patients. Fisher's exact test and logistic regression analysis showed that female, positive preoperative urine culture, stone diameter >2.5 cm, operation time >90 min, operator experience (<100 cases) and diabetes were risk factors for urinary sepsis. ROC showed that these risk factors could well predict the occurrence of urinary sepsis (AUC=0.926). Of these 19 urinary sepsis patients, 8 of them developed septic shock (42.1%) and 3 of them died (15.8%). In 12 cases of urinary sepsis eatients, imipenem was used in the early stage of urinary sepsis, only 1 case developed septic shock. The remaining 7 cases all developed septic shock, and 3 of them died. ConclusionsFemale, preoperative urine culture positive, calculi diameter >2.5 cm, operation time > 90 min, operator experience (<100 cases) and diabetes were risk factors for urinary sepsis, and these risk factors have good predictive efficiency for urinary sepsis caused by PCNL. And application of broad-spectrum antibiotics in early stage is effective way to decrease the risk of urinary sepsis.