输尿管镜碎石术后并发全身炎症反应综合征的危险因素分析  

Evaluation of risk factors of postoperative systemic inflammatory response syndrome after ureteroscopy

作　　者：王伟[1] 韦华玉[1] 玉海[1] 梁建波[1] 李伟[1] 李信众[1] 胡斌[1] 蓝志相[1] Wei Wang;Hua-yu Wei;Hai Yu;Jiang-bo Liang;Wei Li;Xin-zhong Li;Bin Hu;Zhi-xiang Lan(Department of Urology,the People's Hospital of Guangxi Zhuang Autonomous Region,Nanning,Guangxi Zhuang Autonomous Region 530021,China)

机构地区：[1]广西壮族自治区人民医院泌尿外科,广西南宁530021

出　　处：《中国现代医学杂志》2018年第25期56-60,共5页China Journal of Modern Medicine

基　　金：广西壮族自治区卫生和计划生育委员会科研课题(No:Z2016616)

摘　　要：目的探讨输尿管镜碎石术后并发全身炎症反应综合征的危险因素。方法回顾性分析2014年1月-2016年12月在该院确诊为输尿管结石并接受输尿管镜碎石术治疗的206例患者的临床资料。根据术后是否发生全身炎症反应综合征(SIRS)分为SIRS组和非SIRS组,比较两组患者相关临床指标的差异,并对可能与SIRS有关的因素进行多因素Logistic回归分析。结果术后SIRS发生率为16.02%;两组的术前尿培养结果、结石大小和手术时间比较,差异有统计学意义(P<0.05),术后24 h两组的血降钙素原、细菌内毒素浓度比较,差异有统计学意义(P<0.05),SIRS组均高于非SIRS组;多因素Logistic回归分析结果显示结石大小[O^R=1.67(95%CI:1.08,2.54),P=0.002]、手术时间[O^R=2.08(95%CI:1.54,2.73),P=0.000]、术前尿细菌培养[O^R=2.85(95%CI:2.12,3.74),P=0.000]、术后24 h血降钙素原[O^R=5.24(95%CI:2.21,11.35),P=0.000]、及细菌内毒素[O^R=2.68(95%CI:1.98,3.40),P=0.000]与术后SIRS的发生具有相关性。结论输尿管镜碎石术后并发全身炎症反应综合征受多种因素的影响,术前中段尿细菌培养结果、结石大小、手术时间、术后血降钙素原及细菌内毒素水平是术后发生SIRS的危险因素。Objective To assess the risk factors for postoperative systemic inflammatory response syndrome(SIRS)in patients undergoing ureteroscopy for ureteral calculi.Methods A retrospective analysis of clinical data of 206 patients undergoing ureteroscopy for ureteral calculi in our department from January 2014 to December 2016 was performed.All patients were categorized into a SIRS group and a non-SIRS group according to postoperative SIRS status.The potential risk factors of SIRS were compared between the two groups.Then multivariable logistic regression analysis was performed,and odds ratio(O^R)and 95%confidence interval(95%CI)were calculated to identify the independent risk factors.Results The incidence of postoperative SIRS of the observation group was 16.02%.The SIRS group appeared to have significantly larger stone size,longer operative time and higher levels of procalcitonin(PCT)and endotoxin as compared with the non-SIRS group(P<0.05).After multivariable logistic regression analysis,stone size[O^R=1.67(95%CI:1.08,2.54),P=0.002],operative time[O^R=2.08,(95%CI:1.54,2.73),P=0.000],urinary calculi composition[O^R=2.85(95%CI:2.12,3.74),P=0.000],serum procalcitonin 24 h after operation[O^R=5.24(95%CI:2.21,11.35),P=0.000]and bacterial endotoxin[O^R=2.68(95%CI:1.98,3.40),P=0.000]were considered as independent risk factors of SIRS after ureteroscopy.Conclusions A variety of factors affect the incidence of SIRS after undergoing ureteroscopy.Urinary calculi composition,stone size,operative time,postoperative procalcitonin(PCT)and endotoxin levels are independent risk factors for post-operative SIRS.

关 键 词：全身炎症反应综合征 输尿管镜取石术 危险因素 输尿管结石 

分 类 号：R693[医药卫生—泌尿科学]