经皮肾镜取石术后发热的影响因素分析及防治策略  

Risk factors of fevers and prophylaxis policy after percutaneous nephrostolithotomy

作　　者：张慕淳[1] 张刚[1] 张赟[1] 张茁[1] 晋学飞[1] 王金辉[1] 马天武[1] 朱继红[2] 

机构地区：[1]吉林大学中日联谊医院泌尿外科,长春130031 [2]吉林大学第一医院妇科

出　　处：《中华泌尿外科杂志》2011年第10期671-674,共4页Chinese Journal of Urology

摘　　要：目的探讨经皮肾镜取石（PCNL）术后发热的影响因素及防治策略。方法回顾性分析2008—2011年收治320例肾结石行PCNL术的患者资料。男233例，女87例。年龄22，72岁，平均42岁。结石直径0．8～6．0cm，平均3．0cm。分析术后发热患者的年龄结构（〉60岁与≤60岁）、结石大小（〉2．0与≤2．0em）、手术时间（〉60与≤60min）、术中冲洗液灌注泵压力（〉120与≤120mmHg，1mmHg=0．133kPa）、有无梗阻情况、术前是否有尿路感染等因素，比较各因素与2组间发热率的关系。结果320例患者术后出现发热（体温〉38℃）59例（18．4％），其中发生脓毒败血症2例。结石直径〉2．0cm组患者术后发热率为22．4％，≤2．0cm组为10．4％；手术时间〉60min组患者术后发热率为27．2％，≤60min组为10．4％；术中灌注泵压力〉120mmHg组发热率28．3％，≤120／FIEHg组为11．0％；组间发热率比较差异均有统计学意义（P〈0．05）。结论结石直径〉2．0cm、手术时间〉60min、冲洗液灌注泵压力〉120ITIITIHg是导致PCNL术后发热的影响因素；术前预防应用广谱抗生素、缩短手术时间、低压灌注冲洗是预防术后发热的有效措施。Objective To analyze the risk factors of fevers after percutaneous nephrostolithotomy （PCNL） and to determine a more effective prophylaxis method. Methods A retrospective analysis of 320 cases who underwent PCNL for renal calculi from 2008 to 2011 （ men 233, women 87, age between 22 years to 72 years） was made. The average age of the patients and the average diameter of the stones were 42 years and 3cm（0.8 -6 cm） , respectively. We analyzed factors such as age （ 〉60 years and ≤60 years） , stone size （ 〉2.0 cm and ≤2.0 cm）, operative time （ 〉60 min and ≤60 min）, irrigation pump pressure （ 〉 120 mm Hg and ≤120 mm Hg） , obstructive conditions, preoperative urinary tract infection and fever. Wethen compared the fever rate with each of the risk factors. Results There were 59 cases with fever after PCNL; 18.4% of the cases had a temperature over 38℃. There were two cases of pyemia. The patients whose stone diameter 〉 2 cm had a post-operative fever rate of 22.4%. The fever rate in patients whose stone diameter ≤2.0 cm was 10.4%. The fever rate in patients with an operative time 〉60 min and ≤60 min was 27.2% and 10.4% , respectively. Patients with irrigation pump pressure 〉 120 mm Hg and ≤120 mm Hg had post-operative fever rates of 28.3% and 11.0% , respectively. There was statistical significance between each post-operative fever risk factor group. Conclusions The post PCNL fever risk factors are stone diameter 〉 2.0cm, operation time ≤60 min and irrigation pump pressure 〉 120 mm Hg. The effective prophylaxis policy of post-operative fever are the pre-operative using of broad-spectrum antibacterial agents, shorter operative time and lower irrigation pump pressure. A two-stage operation procedure will also reduce the post-operative fever.

关 键 词：经皮肾镜取石术 肾结石 发热 

分 类 号：R699[医药卫生—泌尿科学]