输尿管结石行钬激光碎石术后感染病原学分析及尿液相关因子研究  

Etiological characteristics of urinary tract calculi after holmium laser lithotripsy and the effects of urine related factors research

作　　者：杨森[1] 木海琦[1] 王怡君[1] 南存金[1] 王帅彬[1] 陈超豪 陈映鹤[1] Yang Sen;Mu Haiqi;Wang Yijun;Nan Cunjin;Wang Shuaibin;Chen Chaohao;Chen Yinghe(Department of Urology,the Second Affiliated Hospital of Wenzhou Medical University,Wenzhou 325027, China)

机构地区：[1]温州医科大学附属第二医院泌尿外科,325027

出　　处：《中华实验外科杂志》2019年第1期154-156,共3页Chinese Journal of Experimental Surgery

基　　金：2015浙江省自然科学基金项目(LY15H050007);2017年温州市科技局基金项目(Y20170100).

摘　　要：目的探讨输尿管结石行钬激光碎石术患者术后感染病原学特点分析及尿液相关因子影响。方法选择输尿管结石患者490例,均行输尿管镜钬激光碎石术,分析术后感染情况。分离培养术后感染患者病原菌,且进行耐药性分析;并观察感染与未感染患者尿液C反应蛋白(CRP)、降钙素原(PCT)、白细胞计数(WBC)和白细胞介素(IL)-6水平变化。结果输尿管结石490例患者发生术后感染51例,感染率为10.41%。输尿管结石术后感染51例患者分离病原菌67株,以革兰阴性菌为主,共39株,占58.21%;其次为革兰阳性菌为主,分离出26株,占38.81%。分离病原菌中主要为大肠埃希菌15株、铜绿假单胞菌10株、肠球菌属10株、金黄色葡萄球菌8株。主要革兰阴性菌中,大肠埃希菌对头孢哌酮耐药率为80.00%,铜绿假单胞菌对头孢他啶耐药率为80.00%。主要革兰阳性菌中,肠球菌属对青霉素耐药率为70.00%,金黄色葡萄球菌对青霉素耐药率为75.00%。感染组尿液CRP、PCT、WBC和IL-6水平高于未感染组,且有统计学差异(t=67.728、87.672、24.726、30.941,P均<0.01)。结论输尿管结石行钬激光碎石术患者术后感染病原菌以革兰阴性菌为主,且感染患者尿液相关因子水平明显升高,对评估感染具有参考价值。Objective To investigate the pathogenic characteristics of postoperative infection of ureteral lithiasis with holmium laser lithotripsy and the effects of urine related factors research on ureteral lithotripsy.Methods 490 Cases of ureteral calculi treated in the hospital during January 2013 to 2018 January were selected as the research subjects. Ureteroscopy holmium laser lithotripsy was performed to analyze the incidence of postoperative infection. The pathogenic bacteria of the infected patients were isolated and analyzed, and the changes of C-reactive protein (CRP), procalcitonin (PCT), white blood cells (WBC) and interleukin (IL)-6 in the urine of the infected and uninfected patients were analyzed.Results In 490 patients with ureteral calculi, 51 cases had postoperative infection, and the infection rate was 10.41%.67 strains of pathogenic bacteria were isolated from 51 cases of ureteral lithiasis infection, 39 strains were isolated from Gram-negative bacteria and 58.21% were isolated, followed by Gram-positive bacteria, 26 strains were isolated, accounting for 38.81%. Among the isolates, 15 were Escherichia coli, 10 were Pseudomonas aeruginosa, 10 were Enterococcus and 8 were Staphylococcus aureus. Among the main Gram-negative bacteria, the resistance rate of Escherichia coli to cefoperazone was 80%, and the resistance rate of Pseudomonas aeruginosa to ceftazidime was 80%. Among the main Gram-positive bacteria, the resistance rate of Enterococcus to penicillin was 70%, and the resistance rate of Staphylococcus aureus to penicillin was 75%. The levels of urine CRP, PCT, WBC and IL-6 in the infection group were higher than those in the non infected group (t=67.728, 87.672, 24.726, 30.941, P<0.01).Conclusion The pathogenic bacteria of ureteral lithotripsy are mainly Gram-negative bacteria after holmium laser lithotripsy, and the levels of related factors research in the urine of the infected patients are obviously increased, which are of important reference value for evaluating the infection and should be used f

关 键 词：输尿管结石 钬激光碎石术 术后感染 病原学 C反应蛋白 降钙素原 白细胞计数 白细胞介素-6 

分 类 号：R699[医药卫生—泌尿科学]