上尿路结石患者经皮肾镜术后全身炎性反应综合征发生情况及危险因素分析

目的探讨上尿路结石患者经皮肾镜碎石术(percutaneous nephrolithotripsy,PCNL)后全身炎性反应综合征(systemic inflammatory response syndrome,SIRS)发生情况及危险因素分析。方法回顾性分析我院泌尿外科2014年1月-2015年5月收治的PCNL后患者268例的临床资料。结果 Logistic多因素回归分析显示,糖尿病、术前尿培养阳性、肾积水、肾功能不全、结石数目多发、腹腔操作时间≥60 min、术后残石、未使用敏感药物、鹿角结石、术中灌注量≥500 ml/min、有ESWL史均为SIRS的相关危险因素(OR=2.145、4.368、2.368、2.794、4.442、4.687、3.997、3.457、3.129,P0.05)。结论泌尿系统感染是SIRS的主要原因,预防性应用抗菌药物积极控制血糖,术中尽量缩短腹腔内操作时间,控制灌洗液流量,术后严密监控,可降低SIRS发生率。

Systemic Inflammatory Response Syndrome after Percutaneous Nephrolithotripsy in Patients with Upper Urinary Tract Lithiasis and Risk Factor Analysis

Objective To investigate the occurrence and risk factors of systemic inflammatory response syndrome (SIRS) among patients with upper urinary tract lithiasis after percutaneous nephrolithotripsy.Methods The clinical data of 268 patients undergoing percutaneous nephrolithotripsy in our hospital between January 2014 and May 2015 were retrospectively analyzed.Results Logistic analysis showed that diabetes,preoperative urine culture,hydronephrosis,renal insufficiency,multiple stones,intraabdominal operation time of more than 60 min,postoperative residual stone,use of no sensitive drugs,staghorn calculi,intraoperative perfusion≥500 ml/min and ESWL history were risk factors of SIRS (OR=2.145,4.368,2.368,2.794,4.442,4.687,3.997,3.457,3.129,P＜0.05).Conclusion Urinary tract infection is a major cause of SIRS.Preventive use of antibiotics,positive control of blood glucose,shortening of intracavity operation time,control of lavage fluid flow and postoperative surveillance can help to reduce the incidence of SIRS.