经皮肾镜碎石术后感染性休克患者开放肾造瘘管必要性的研究

目的探讨经皮肾镜碎石术(PCNL)术后留置双J管患者发生感染性休克开放肾造瘘管的必要性,为PCNL术后感染性休克的治疗提供参考依据。方法选取某院2015年1月1日—2016年12月30日因PCNL术后并发感染性休克患者60例,将患者随机分为肾造瘘管夹闭组(30例)与肾造瘘管开放组(30例),收集两组相关临床资料进行分析。结果两组患者治疗24 h后心率(HR)、平均动脉压(MAP)、氧饱和度(SpO_2)、血清乳酸(Lac)、每小时尿量均较治疗前明显改善(均P0.05);开放组患者治疗24 h后HR、MAP、SpO_2、Lac、每小时尿量与夹闭组比较,差异均有统计学意义(均P0.05)。两组患者治疗3 d后血清降钙素原(PCT)、C反应蛋白(CRP)均较治疗前明显下降(均P0.05);开放组患者治疗3 d后血清PCT、CRP均低于夹闭组(均P0.05);两组患者治愈好转率均为100.00%,开放组患者术后住院时间和拔管时间均短于夹闭组,总住院费用少于夹闭组,差异均有统计学意义(均P0.05)。结论PCNL术后感染性休克的患者在常规留置双J管的基础上开放肾造瘘管是有必要的。

Necessity of opening the nephrostomy tube for patients with septic shock after percutaneous nephrolithotomy

ObjectiveTo explore the necessity of opening nephrostomy tube for patients with septic shock following the indwelling double J stent of post percutaneous nephrolithotomy (PCNL), and provide reference for the treatment of septic shock after PCNL. Methods60 patients with septic shock after PCNL in a hospital from January 1, 2015 to December 30, 2016 were chosen, patients were randomly divided into clipping nephrostomy tube group (clipping group, n=30) and opening nephrostomy tube group (opening group, n=30), clinical data of two groups of patients were collected and analyzed. ResultsAfter 24 hour treatment, heart rate (HR), mean arterial pressure (MAP), oxygen saturation (SpO2), serum lactate (Lac), and hourly urine volume all improved in both groups of patient compared with pre treatment(all P<0.05); HR, MAP, SpO2, Lac, and hourly urine volume in opening group after 24 hour treatment were all significantly different from clipping group (all P<0.05). Levels of serum procalcitonin (PCT) and C reactive protein (CRP) in two groups after 3 day treatment decreased significantly compared with pre treatment (both P<0.05); PCT and CRP levels in opening group after 3 day treatment were both significantly lower than clipping group (both P<0.05); cure rate of two groups were both 100.00%, hospitalization time and extubation time in opening group were both shorter than clipping group, and cost was less than clipping group, difference were all significant(all P<0.05). ConclusionOpening nephrostomy tube on the basis of indwelling double J stent is necessary for patients with septic shock after PCNL.