经输尿管镜碎石术后感染性休克并急性肺损伤的救治分析  

Retrospective analysis of the treatment of acute lung injury/acute respiratory distress syndrome in postpercutaneous nephrolithotomy septic shock

作　　者：杨雪飞[1] 王耀丽[1] 李鹏飞[1] 雷洋[1] 周健[1] 

机构地区：[1]第三军医大学大坪医院重症医学科,重庆400042

出　　处：《中华肺部疾病杂志（电子版）》2016年第4期372-376,共5页Chinese Journal of Lung Diseases(Electronic Edition)

基　　金：国家自然科学基金青年项目(81200057)

摘　　要：目的 探讨输尿管镜碎石术后感染性休克继发急性肺损伤/急性呼吸窘迫综合征（ALI/ARDS）的治疗方法。方法 总结分析15例输尿管镜碎石术后感染性休克继发ALI/ARDS患者的临床表现和治疗方法。患者在输尿管镜碎石术后2~78 h出现ALI/ARDS表现,予以抗感染、机械通气、糖皮质激素、连续性肾脏替代治疗（CRRT）、营养支持等综合治疗。结果 15例患者中,即使是合适的术前泌尿系统抗感染的治疗,术后安置输尿管内双J管的扩张引流,也并不能完全防止输尿管镜碎石术后出现全身炎症反应,引发ALI/ARDS。菌血症和全身炎症反应综合征（SIRS）持续时间影响着住院时间和预后。本组15例患者诊断感染性休克至出现ALI/ARDS时间25.13 h;CRRT替代治疗8例（53.3%）;平均在科时间10.8 d;机械通气时间平均72 h;治愈13例,自动出院2例。结论 对输尿管镜碎石术后感染性休克继发急性肺损伤/急性呼吸窘迫综合征（ALI/ARDS）的患者,早期发现诊断、积极合理的抗生素应用、有效的机械通气支持、精确的容量管理、糖皮质激素的补充及营养支持,同时在上述综合治疗的基础上增加CRRT协助治疗可提高治疗成功率。Objective To investigate the epidemiology, the current status of clinical diagnosis and treatment and risk factors of acute lung injury/acute respiratory distress syndrome （ALI/ARDS） in post- percutaneous nephrolithotomy septic shock. Methods All the medical records of 15 patients with acute lung injury/acute respiratory distress syndrome in post-percutaneous nephrolithotomy septic shock from January 2015 to December 2015 in the Daping Hospital were searched. Clinical characteristics, age, basic disease, clinical symptoms were analyzed. ALI/ARDS in patients in 2-78 hpost-percutaneous nephrolithotomy septic shock, anti- infection, mechanical ventilation, glucocorticoid, CRRT, nutritional support and other comprehensive treatment were given. Results Among the 15 severe ALI/ARDS patients, even if the appropriate preoperative anti- infection treatment of urinary system, the double-j dilating drainage tube was placed, also did not prevent inflammatory response in post-percutaneous nephrolithotomy septic shock, the cause of ALI/ARDS. Bacteremia and duration of SIRS affected the length of hospital stay and prognosis. This 15 patients in the diagnosis of septic shock to appear ALI/ARDS time was 25.13 h; C RRT replacement therapy 8 cases （53.3%） ; The average time was 10.8 d; average mechanical ventilation was 72 h; 13 casescure, 2 cases auto-discharge. Conclusions For acute lung injury/acute respiratory distress syndrome（ALI/ARDS） in post-percutaneous nephrolithotomy septic shock, found early diagnosis, active and reasonable application of antibiotics, effective mechanical ventilation support, accurate capacity management, supplement of glucocorticoid and nutritional support, at the same time, on the basis of the comprehensive treatment increase the CRRT treatment can improve the treatment success rate

关 键 词：泌尿系统感染 感染性休克 急性肺损伤/急性呼吸窘迫综合征 

分 类 号：R563.1[医药卫生—呼吸系统]