体外冲击波碎石导致机体感染可能性的研究  

Investigation of infectious risks and the value of antibiotic prophylaxis during ESWL

作　　者：沈周俊[1] 李兰娟[2] 傅素珍[2] 程广[1] 魏泽庆[2] 

机构地区：[1]浙江大学医学院附属第一医院泌尿外科,杭州310003 [2]浙江大学医学院附属第一医院传染病实验室

出　　处：《中华泌尿外科杂志》1999年第11期652-654,共3页Chinese Journal of Urology

摘　　要：目的　探讨体外冲击波碎石（ＥＳＷＬ） 引起全身和泌尿系统感染的可能性及预防性使用抗生素的价值。　方法　留取４１ 例不同部位与复杂程度的泌尿系统结石病人ＥＳＷＬ 治疗前和治疗后的血、尿标本，分别作细菌培养，并以偶氮显色法作内毒素浓度测定。　结果　（１） 不同部位与复杂程度的泌尿系统结石病人ＥＳＷＬ 治疗前后血液内毒素浓度均无显著性变化，血液的细菌培养均为阴性。（２） 肾结石直径＞ ２ｃｍ ，多发性肾结石、铸型或鹿角形肾结石或肾结石合并输尿管结石的病人ＥＳＷＬ治疗后的尿液内毒素浓度为（６５ ．３４ ±３２．１７）ｎｇ／Ｌ，显著高于治疗前的内毒素浓度（２１ ．２８ ±６ ．５６）ｎｇ／Ｌ，Ｐ＜ ０ ．０５ ；尿液的细菌阳性率也从治疗前的１／８ 增加为３／８ 。（３） 单发直径≤２ ｃｍ 的肾结石及单纯输尿管结石病人ＥＳＷＬ 治疗前后尿液内毒素浓度无显著升高，尿液的细菌阳性率也无变化。　结论　ＥＳＷＬ 造成泌尿系结石病人全身感染的可能性小，但引起复杂性、多发性结石病人尿路感染的可能性较大，这些病人ＥＳＷＬObjectives To clarify the infection risk of ESWL and the value of antibiotic prophyla xis. Methods Samples of urine and blood of 41 urolithiasis patients were collected before and after ESWL for study.All the samples were cultured for bacteria and studied for endotoxin. Results No significant difference in serum endotoxin concentration was noted before and after ESWL in all the urolithiasis patients and blood cultures for bacteria were all negative.In patients with complicated,casting,staghorn renal calculi and in renal calculus accompanied by ureteral calculus there was a significant increase of urine endotoxin after ESWL ( P <0.05).The positive rate of urine bacteria culture was increased after ESWL (1/8 vs 3/8).In simple renal stones (≤2.0cm in diameter) and ureteral stones there was no significant difference of urine endotoxin before and after ESWL and so was urine bacteria culture. Conclustions Urinary infection risk is low in simple solitary stone following ESWL but is high in complicated stones.So,prophylactic antibiotics needed for complicated urolithiasis before ESWL.

关 键 词：感染 泌尿系结石 体外震波碎石 

分 类 号：R691.405[医药卫生—泌尿科学]