上尿路结石经皮肾镜术后全身炎症反应综合征的危险因素分析  

Risk factors of systemic inflammatory response syndrome after percutaneous nephrolithotomy for upper urinary tract calculi

作　　者：史建国[1] 王领军[1] 陈宇东[1] 刘同伟[1] 白新宇[1] 王强[1] 韩刚[1] 王志鹏[1] 殷晓松[1] 苑海波[1] 王卫宁[1] 李春吾[1] SHI Jianguo WANG Lingjun CHEN Yudong LIU Tongwei BAI Xinyu WANG Qiang HAN Gang WANG Zhipeng YIN Xiaosong YUAN Haibo WANG Weining LI Chunwu(Department of Urology, 252nd Hospital of PLA, Baoding 071000, Hebei Province, China)

机构地区：[1]解放军第252医院泌尿外科,河北保定071000

出　　处：《解放军医学院学报》2016年第9期964-966,983,共4页Academic Journal of Chinese PLA Medical School

摘　　要：目的探讨上尿路结石经皮肾镜术后全身炎症反应综合征(systemic inflammatory response syndrome,SIRS)的危险因素。方法回顾本院泌尿外科2012年5月-2015年9月267例经皮肾镜碎石术后患者的临床资料,通过单因素及多因素Logistic回归分析全身炎症反应综合征的危险因素。结果 267例中,41例(15.4%)出现SIRS表现。其中4例病情加重发生感染性休克,经积极抗感染、对症支持治疗后均恢复,无死亡病例。单因素分析结果表明反复尿路感染病史、手术时间、结石负荷、鹿角形结石与术后SIRS的发生具有相关性。多因素分析发现术前反复尿路感染病史(OR=6.759,P<0.01)、鹿角形结石(OR=6.501,P<0.01)是经皮肾镜术后并发SIRS的独立危险因素。结论对于具有反复尿路感染病史以及鹿角形结石的患者要提高警惕,术前积极控制感染,术中注意无菌操作、避免集合系统损伤,术后严密监控,以降低SIRS发生率。Objective To investigate the risk factors of systemic inflammatory response syndrome（SIRS） after percutaneous nephrolithotomy（PCNL） for upper urinary tract calculi. Methods Clinical data about 267 cases who had undergone percutaneous nephrolithotomy in our department from May 2012 to September 2015 were retrospectively analyzed. Univariate analysis and Logistic regression analysis were performed to assess the risk factors of postoperative SIRS. Results Of the 267 patients, 41（15.4%） cases had SIRS manifestations including 4 cases of septic shock. After anti-infection and symptomatic treatment, all patients were fully recovered without dead cases. In univariate analysis, a history of recurrent urinary tract infection, operative time, stone burden and staghorn calculi were related to postoperative SIRS. Logistic regression revealed that preoperative recurrent urinary tract infection history（OR=6.759, P 0.01） and staghorn calculi（OR=6.501, P 0.01） were independent risk factors for postoperative SIRS. Conclusion Doctors should be more vigilant to those with recurrent urinary tract infection history and staghorn calculi. Preoperative infection control, intraoperative aseptic technique, avoidance for collecting system damage and postoperative close monitoring are beneficial to reducing the incidence of SIRS.

关 键 词：上尿路结石 经皮肾镜 全身炎症反应综合征 

分 类 号：R692.4[医药卫生—泌尿科学]