输尿管软镜碎石术后患者发生全身炎症反应综合征的影响因素分析  

Influencing factors on occurrence of systemic inflammatory response syndrome after flexible uroterescopy lithothipsy

作　　者：周军 苏耀武 汪超军[2] 陆建军 陈凯强 

机构地区：[1]宁波市北仑区人民医院泌尿外科,浙江宁波315800 [2]浙江大学医学院附属第一医院泌尿外科,浙江杭州310003

出　　处：《中华医院感染学杂志》2017年第21期4942-4945,共4页Chinese Journal of Nosocomiology

基　　金：浙江省医学会临床科研基金资助项目(2011ZYC-A02)

摘　　要：目的探讨输尿管软镜碎石术后患者发生全身炎症反应综合征(SIRS)的影响因素。方法收集医院泌尿外科2012年1月-2016年12月收治的296例泌尿系结石患者的临床资料,所有患者住院后均行输尿管软镜碎石术(FURL),分析SIRS的发生率及发生SIRS的相关因素,并应用多因素非条件logistic回归分析术后患者发生SIRS的独立影响因素。结果纳入患者中25例术后发生SIRS,发生率为8.45%;SIRS发生与性别、肾结石大小、肾积水程度、手术时间长短、结石培养及术前中段尿培养阳性等因素相关(P<0.05),与结石位置及年龄无相关性(P>0.05);术前中段尿培养阳性56例,阳性率为18.9%,结石培养阳性62例,阳性率为20.9%,其中大肠埃希菌和葡萄球菌累计检出率>60%;logistic回归分析显示,性别、手术时间、肾积水程度和结石培养阳性是FURL后SIRS发生的独立影响因素(P<0.05)。结论 FURL术后发生SIRS相关因素较多,临床医师需严格控制手术时间,依据手术前后培养结果,合理应用抗菌药物,降低术后SIRS发生率,提高诊疗质量。OBJECTIVE To explore the influencing factors on occurrence of systemic inflammatory response syndrome（SIRS）after flexible uroterescopy lithothipsy（FURL）.METHODS A total of 296 patients with urinary calculus treated in urinary surgery department in our hospital from Jan.2012 to Dec.2016 were enrolled retrospectively and the clinical data of the patients were collected.All the patients enrolled were treated with FURL.The occurrence of SIRS and the correlated factors influencing the occurrence of SIRS were analyzed,and the independent influencing factors of the occurrence of SIRS after operation were analyzed by multivariable non-conditional logistic regression analysis.RESULTS Of the 296 patients enrolled,25 cases manifested SIRS after operation,with occurrence rate of 8.45%.The occurrence of SIRS was closely correlated with gender,size of renal lithiasis,degree of nephrohydrosis,time of operation,and positive culture result of calculus and mid-stream urine culture before operation（P〈0.05）,while had no relationship with the location of calculus and age.The cases of the positive culture result of mid-stream urine culture before operation and calculus were 56 and 62,with occurrence rates of 18.9% and 20.9% respectively,and the total detection rate of Escherichia coli and Staphylococcus was above60%.The logistic regression analysis showed that the gender,time of operation,degree of nephrohydrosis and positive culture of calculus were independent influencing factors of the occurrence of SIRS after FURL（P〈0.05）.CONCLUSIONThere are many factors for the occurrence of SIRS after FURL.Clinicians should pay attention to controlling time of operation seriously and rationally using antibiotics according to the culture results before and after the operation,so as to reduce the incidence of SIRS after operation and improve the quality of diagnosis and treatment.

关 键 词：全身炎症反应综合征 输尿管软镜碎石术 影响因素 

分 类 号：R619.3[医药卫生—外科学]