经皮肾镜取石术所致尿源性脓毒血症的预测因子临床分析

目的寻找可以预测患者在经皮肾镜碎石术后从全身炎症反应综合征(SIRS)进展为尿源性脓毒血症的危险因素。方法回顾性分析2014年3月至2016年2月间156例经皮肾镜取石术(PCNL)后并发感染并发症的患者的临床资料。将可能导致尿源性脓毒血症的围手术期危险因素与只发生SIRS的患者进行比较。结果156例患者中的135例仅发展为SIRS,其余21例患者均发展为尿源性脓毒血症。尿源性脓毒血症组术前尿亚硝酸盐阳性率明显高于对照组(P<0.001),结石直径大(P=0.015),手术时间长(P<0.001)。多因素logistic回归分析显示术前尿亚硝酸盐(OR=10.570,P=0.025),结石大小(OR=11.512,P=0.009)和术后血白细胞减少(OR=0.009,P<0.001)。在尿激酶休克前3 h内白细胞计数阈值为2.98×10^9/L。白细胞计数预测尿源性脓毒血症的敏感性和特异性分别为90.5%和92.6%。结论术前尿亚硝酸盐、结石大小和术后白细胞计数与PCNL术后的尿路感染性休克相关。可将PCNL后3 h内白细胞减少低于2.98×10^9/L,可作为尿路感染性休克的预测指标。对于有高危因素的患者发生尿路感染性休克,应在PCNL后3 h内测量白细胞计数。

Clinical analysis of predictors of urinary sepsis caused by percutaneous nephrolithotomy

Objective To find out the risk factors for progression from systemic inflammatory response syndrome(SIRS)to urine sepsis after percutaneous nephrolithotomy(PCNL).Methods We retrospectively analyzed the clinical data of 156 patients with postoperative complications after PCNL from March 2014 to February 2016.Perioperative risk factors that may lead to urinary sepsis were compared with patients who developed SIRS only.Results Of the 156 patients,only 135 developed SIRS,and the remaining 21 patients developed urinary sepsis.The positive rate of urinary nitrite in urine-derived sepsis group was significantly higher than that in the control group(P<0.001),the stone diameter was large(P=0.015),and the operation time was long(P<0.001).Multivariate logistic regression analysis revealed preoperative urinary nitrite(OR=10.570,P=0.025),stone size(OR=11.512,P=0.009),and postoperative blood leucopenia(OR=0.009,P<0.001).The threshold value of white blood cell count was 2.98×10^9/L within 3 hours before urokinase shock.The sensitivity and specificity of white blood cell count prediction for urinary sepsis were 90.5%and 92.6%,respectively.Conclusions Preoperative urinary nitrite,stone size and postoperative leukocyte counts are associated with urinary tract septic shock following PCNL.The leukopenia of less than 2.98×10^9/L within 3 hours after PCNL can be used as a predictor of urinary tract septic shock.For urinary tract septic shock in patients with high-risk factors,white blood cell counts should be measured within 3 hours after PCNL.