上尿路腔内碎石术后感染性休克发生的因素分析和对策  

Analysis on septic shock following endoscopic surgery in upper urinary tract stone patients

作　　者：文博[1] 黄小佳[1] 丘捷文[1] 李晓铭[1] 余贵亮[1] 李春[1] 

机构地区：[1]广东省深圳市宝安人民医院泌尿外科,广东深圳518101

出　　处：《中国内镜杂志》2013年第7期743-746,共4页China Journal of Endoscopy

摘　　要：目的探讨经皮肾镜/输尿管镜取石术后并发感染性休克的发生原因及处理对策。方法回顾性分析2007年10月~2012年10月10例患者行经皮肾镜/输尿管镜取石术后并发感染性休克临床资料。感染性休克诊断明确后,首要措施为补足血容量和控制感染,经验性应用亚胺培南控制感染,应用血管活性药物维持血流动力学稳定,小剂量长效皮质激素和碱性药物的运用对中毒症状明显者极为重要,发生肺部感染顽固性低氧者呼吸机通气辅助呼吸。结果 1例术中出现感染性休克,及时终止手术并转入ICU进一步救治;1例发生在麻醉苏醒过程,转入ICU治疗;8例发生在术后2~8 h,经快速液体复苏,其中4例转入ICU进一步救治,2例出现呼吸衰竭并进行气管插管机械通气维持呼吸。无患者死亡,10例均在3~5 d后逐渐停用血管活性药物,术后3~8 d后体温及血常规恢复正常。结论经皮肾镜/输尿管镜取石术后发生感染性休克原因多为术前未能有效控制感染、手术时间过长、术中肾盂压力过高、肾盂集合系统穿透致冲洗液外渗等。术前充分抗感染治疗及术中提高碎石技巧和低压灌注、分期手术等是减少感染性休克发生的有效途径。成功救治的关键在于对感染性休克的早期诊断及处理。【Objective】 To investigate the etiology and treatment of septic shock following percutaneous nephrolithotomy（PCNL） or ureteroscopic lithtripsy（URSL） for upper urinary tract stones.【Method】10 cases of septic shock following PCNL or URSL from November 2007 to October 2012 were retrospectively analyzed.The first important measure was supplying volume of blood and controlling infections.Broad-spectrum carbapenem（rimipenem） were intravenously injected to control infection.Vasodilation drug should be used under the sufficient expansion,Moreover the usage of low-dose hydrocortisone and alkaline drug was important too.And mechanical ventilation was used for patients who developed respiratory insufficiency.【Results】The septic shock occurred intraoperatively in 1 case,and thus the operation was stopped immediately and the patient was transferred to ICU for further treatment.One patient waked up and showed hypotension and tachycardia after the surgery.The patient was transferred to ICU immediately.The other eight patients developed septic shock 2-8 hours postoperatively,4 of them,who had symptoms of sepsis,were delivered to ICU.No case died.All the patients＇ vital signs were stable within 3 to 5 days,and thus vasoactive drugs were gradually stopped.Their body temperature and blood routine tests then returned to a normal range in 3-8 days.【Conclusion】The general causes of septic shock following PCNL or URL should be that the urinary tract infections could not be controlled availably before operation,long time of operation,hyperpiesia of renal intrapelvic pressure,penetrating injury of the collection system of renal pelvis during the procedure.The best way to reduce the occurrence of septic shock was enough preparation before operation,effective anti-infection,improving the skill of lithotripsy,fluid infusion under hypopiesia and staging operation.The successful keys lie in the early diagnosing and timely treating for septic shock.

关 键 词：经皮肾镜取石术 输尿管镜取石术 感染性休克 

分 类 号：R691.4[医药卫生—泌尿科学]