输尿管结石患者钬激光碎石术后感染性休克的原因与防治研究  

Causes and treatment of septic shock after holmium laser lithotripsy in upper ureteral calculi patients

作　　者：陈海潮[1] 缪起龙[1] 邵法明[1] 孙树本[1] 刘平[1] 

机构地区：[1]宁波大学医学院附属医院泌尿外二科,浙江宁波315020

出　　处：《中华医院感染学杂志》2015年第20期4751-4753,共3页Chinese Journal of Nosocomiology

基　　金：浙江省医药卫生科技基金资助项目(2014KYB238)

摘　　要：目的探讨输尿管上段结石患者输尿管镜下钬激光碎石术后感染性休克的发生原因和预防治疗措施,以降低感染发生率,提高治愈率。方法回顾性分析2012年9月-2015年3月8例行输尿管镜下钬激光碎石术后感染性休克患者的临床资料,查血培养,并予碳青霉烯类抗菌药物抗感染、补液扩容、多巴胺升压、5%碳酸氢钠纠酸及激素治疗。结果 7例患者于术后〈3～4h血压〈90/60mm Hg,心率〉100/min,伴烦躁或意识淡漠,体温〉39.0℃,有寒战、呼吸急促等,另1例患者术后24h出现上述血压、心率变化,伴面色苍白、皮肤湿冷、意识障碍;8例患者均查血常规：白细胞〉20×109/L、中性粒细胞〉90%、C-反应蛋白〉100mg/L,诊断为感染性休克,所有患者经过积极治疗后5d内生命体征平稳,术后8～10d治愈出院,患者年龄≥60岁、合并糖尿病、术前应用抗菌药物、手术时间〉30min等为发生感染性休克的危险因素。结论感染性休克是输尿管镜碎石术尤其是上段结石的严重并发症之一,早期发现并及时有效的处理是抢救成功的关键。OBJECTIVE To explore the causes of septic shock after ureteroscopic holmium laser lithotripsy in upper ureteral calculi patients so as to provide preventive measures ,reduce the incidence rates and improve the curative rate .METHODS A retrospective analysis was conducted on the clinical data of 8 patients with septic shock after ureteroscopic holmium laser lithotripsy between Sep .2012 and Mar .2015 .Their blood were cultured and they re‐ceived treatment of carbapenems for anti‐infection ,fluid infusion for volume expansion ,dopamine for increasing pressure ,5% sodium bicarbonate for adjusting acid and hormone therapy .RESULTS The manifestations of 7 pa‐tients were blood pressure below 90/60 mmHg ,heart rate over 100 BPM ,irritable or clouding of consciousness , ardent fever （〉39 ℃） ,shiver and polypnea within 3 -4 hours after operation .One patient had onset of similar symptoms within 24 hours after operation .All the patients were given blood routine examination .The results showed that WBC〉20 × 109/L ,NE〉90% ,CRP〉100 mg/L ,suggesting the clinical diagnosis of septic shock .All patients had stable vital signs within five days after positive treatment and were discharged in 8-10 d after opera‐tion .Age ≥ 60 years ,complication with diabetes ,preoperative application of antibacterials and operation time〉30 min were risk factors for septic shock .CONCLUSION Septic shock is one of serious complications after uret‐eroscopic lithotripsy ,especially when the urinary stone is in upper ureter .The key to successful rescue is early de‐tection and timely and proper treatment .

关 键 词：输尿管上段结石 输尿管镜碎石术 感染性休克 原因 预防治疗 

分 类 号：R619.3[医药卫生—外科学]