经皮肾镜取石术后并发重症感染的原因探讨及防治

目的:探讨经皮肾镜取石术后并发重症感染的原因及防治措施。方法:回顾性分析2007~2013年我院行经皮肾镜取石术后并发重症感染12例患者的临床资料:男5例,女7例,年龄32~57岁,平均44.5岁。术后0.5~:12h出现寒战、高热,体温达39.0℃以上,血压降至90/50mmHg(1mmHg=0.133kPa)以下,脉压4kPa,心率120次/min;临床表现为面色苍白、皮肤湿冷、呼吸急促、唇指发绀、尿量减少、烦躁不安、意识障碍等。根据临床表现及术前细菌学检查结果,诊断为感染性休克。首要采用维持有效循环容量和控制感染,应用血管活性药物维持血流动力学稳定,监测中心静脉压等措施,使用敏感抗生素抗感染治疗,未获得细菌培养结果者应用三代头孢等广谱抗生素。结果:12例患者均在7~48小时后逐渐停用升压药物,4天后体温及血常规恢复正常,连续3天无发热。结论:经皮肾镜取石术后可发生重症感染,严重者可并发感染性休克。遇此,以抗感染及纠正休克为主。术前预防和充分准备、术中谨慎操作、术后加强生命体征监测是避免重症感染发生的重要手段。

Etiological study and therapeutic and preventive strategy for severe infection after percutaneous nephrolithotomy

Objective：To investigate the etiology and treatment for severe infection after percutaneous nephro- lithotomy. Method：A retrospective analysis was conducted on the clinical data of 12 cases for severe infection after percutaneous nephrolithotomy from 2007 to 2013. Five males and seven females were included. The mean patients age was 44.5 （32-57） years. The patients were characterized by a temperature over 39 ℃, heart rate over 120 BPM, and blood pressure below 90/50 mmHg （1 mmHg=0. 133 kPa） within 0.5-12 hours after the operation. Clinical expression was pale, clammy skin, shortness of breath, cyanosis, decreased urinary output, restlessness, disturbance of consciousness. Patients were diagnosed as septic shock according to clinical manifestation and bacte- riologic studies. The first important measure was supplying volume of blood and controlling infections. The vaso- active drugs were used for the establishment of stable circulation. Moreover, central venous pressure should be closely monitored. Antibiotics were used according to the results of bacterial culture. Result： All patients were gradually discontinued pressor drugs 7-48 hours later, and the body temperature and blood routine returned to normal four days later. No fever occurred for the next three days. Conclusion： Severe infection may occur after percutaneous nephrolithotomy, even septic shock may happen. Antiinfection and antishock should be paid much attention. Adequate preoperative preparation, careful operation and close monitoring of the vital signs can effectively prevent the infection.