结石细菌培养在经皮肾镜取石术中的临床意义

目的 探讨结石细菌培养与经皮肾镜取石术(percutaneous nephrolithotomy,PCNL)术后全身炎症反应综合征(systemic inflamatory response syndrome,SIRS)发生的相关性,评价结石培养在经皮肾镜术后SIRS治疗方面的作用.方法 回顾分析66例经皮肾镜手术患者的相关临床资料,采用多因素分析评估结石细菌培养、术前尿细菌培养、年龄、性别、术前是否预防性使用抗生索、结石体积、手术时间、通道数目等8种因素与术后SIRS的相关性.比较结石培养结果与膀胱尿细菌培养结果的差异.结果 单因素及多因素分析结果表明结石细菌培养与术后SIRS的发生显著相关(P<0.05);结石细菌培养阳性率明显高于膀胱尿细菌培养(48.48%:30.30%);术后21例SIRS患者中,共有14例(66.67%)根据结石细菌培养+药敏检测结果选择使用抗生素,均得到有效控制.结论 结石细菌培养阳性与PCNL术后SIRS发生显著相关,与传统膀胱尿细菌培养相比具有明显优势,其药敏检测结果对术后抗生素的选择有指导意义,建议常规检查.

Clinical implication of stone culture in percutaneous nephrolithotomy

Objective To evaluate the correlation between stone culture and SIRS,ascertain the clinical implication of stone culture in PCNL. Methods Clinical data of 66 patients who underwent PCNL in our department were analyzed retrospectively.Eight risk factors including stone culture+drug sensitivity,urine culture+drug sensitivity,age,gender,prophylactic antibiotics,stone volume,operative time and the number of tract. Multiple statistics methods were used for analysis to evaluate the impact of SIRS,and compare the difference between stone culture and urine culture.Results Univariate analysis and Multivariate logistic regression model showed that positive stone culture was the risk factor of SIRS (P<0.05).Positive stone culture was found in 48.48% patients,which was higher than that of urine culture (30.30%).Fourteen patients(66.67%) of 21 postoperative SIRS patients were prescribed antibiotics according to the stone culture rosult. And all of them recovered unevently without developing septic shock or MODS.Conclusions Positive stone culture is the important risk factor of post-PCNL SIRS.Stone culture is better than urine culture in directing postoperative antibiotics prescribsion and should be routinely used.