感染可能性评分对输尿管软镜术后尿源性脓毒血症的筛查预测效果分析  

Screening and predict effectiveness of infection possibility score on urinary sepsis after ureteroscopic soft-surgery

作　　者：赵明[1] 何锦华[1] 金珊[1] 李月明 易虎[1] ZHAO Ming;HE Jin-hua;JIN Shan;LI Yue-ming;YI Hu(First Hospital Affiliated to Tianjin Medical University,Tianjin 300193,China)

机构地区：[1]天津中医药大学第一附属医院泌尿外科,天津300193

出　　处：《中华医院感染学杂志》2018年第24期3823-3826,共4页Chinese Journal of Nosocomiology

基　　金：天津卫生局中医中西医结合基金资助项目(2013JYL015)

摘　　要：目的研究分析感染可能性评分(infection probability score,IPS)对于行输尿管软镜术后患者发生尿源性脓毒血症的筛查预测效果。方法研究纳入医院2016年1月-2017年12月收治的行输尿管软镜术治疗的196例患者,以炎症反应作为诊断标准,遵照随机分配原则分为对照组108例与试验组88例,对试验组患者进行细菌培养分析,并检测对比两组患者血清降钙素原(procalcitonin,PCT)、C-反应蛋白(C-reactionprotein,CRP)以及白细胞(white blood cell,WBC)水平,对IPS评分在术后尿源性脓毒血症的预筛查中的价值进行分析。结果试验组中88例患者共培养病原菌102株,其中革兰阴性菌82株占80.39%、革兰阳性菌20株占19.61%,革兰阴性菌中以大肠埃希菌为主;血清指标检测结果显示,试验组患者PCT、CRP以及WBC水平均高于对照组患者(P<0.05);试验组患者IPS评分均高于对照组患者(P<0.05)。结论输尿管软镜术后尿源性脓毒血症患者主要感染病原菌为革兰阴性菌,患者CRP及WBC水平均有所升高,应用IPS评分可有效鉴别患者术后感染情况,对于尿源性脓毒血症的诊断准确性较高,在临床预测筛查中有一定的应用价值。OBJECTIVE To investigate the effect of infection probability score (IPS)on the screening and prediction of urinary sepsis in patients undergoing ureteroscopy.METHODS A total of 196patients who underwent ureteroscopy in the hospital from Jan.2016 to Dec.2017 were enrolled.The inflammatory response was used as the diagnostic criterion.According to the randomized principle,108 patients in the control group and 88 patients in the experimental group were included.Patients in the experimental group were analyzed for bacterial culture,and serum levels of procalcitonin (PCT),C-reaction protein (CRP),and white blood cell (WBC)were compared between the two groups.The value of IPS in pre-screening of postoperative urinary sepsis was analyzed.RESULTS From the 88 patients in the experimental group,102 strains of pathogens were cultured,of which 82 strains of gram-negative bacteria accounted for 80.39%,20 strains of gram-positive bacteria accounted for 19.61%,and Escherichia coli was the main gram-negative bacteria.Serum index detection results showed that the PCT,CRP and WBC levels in the experimental group were significantly higher than those in the control group (P<0.05).The IPS scores in the experimental group were significantly higher than those in the control group (P<0.05).CONCLUSION The main pathogens of urinary sepsis after ureteroscopy are gram-negative bacteria,and the levels of CRP and WBC are increased.The IPS score can effectively identify the postoperative infection of patients.The diagnostic accuracy of urinary sepsis is high,and it has certain application value in clinical prediction screening.

关 键 词：感染可能性评分 输尿管软镜术 尿源性脓毒血症 筛查 

分 类 号：R631.1[医药卫生—外科学]