经皮肾镜取石术后全身炎症反应综合征麻醉相关危险因素分析  

Analysis on anesthesia related risk factors for systemic inflammatory response syndrome after percutaneous nephrolithotomy

作　　者：闵卫翔[1] 马德祥[1] 陈涵 闵宇 MIN Weixiang;MA Dexiang;CHEN Han;MIN Yu(Department of Anesthesiology,Sichuan Provincial Academy of Medical Sciences/Sichuan Provincial People′s Hospital,Chengdu,Sichuan 610072,China;Southwest MedicalUniversity,Luzhou,Sichuan 646000,China;North Sichuan Medical College,Nanchong,Sichuan 637000,China)

机构地区：[1]四川省医学科学院/四川省人民医院麻醉科,成都610072 [2]西南医科大学,四川泸州646000 [3]川北医学院,四川南充637000

出　　处：《现代医药卫生》2019年第2期215-218,共4页Journal of Modern Medicine & Health

摘　　要：目的回顾性分析经皮肾镜取石术(PCNL)后全身炎症反应综合征(SIRS)的麻醉相关危险因素,为防治PCNL后SIRS提供科学依据。方法选取2015年1月至2017年6月四川省人民医院泌尿外科收治的行PCNL治疗的肾结石患者643例。根据SIRS诊断标准将PCNL后患者分为SIRS组(89例)和非SIRS组(554例)。采用logisitic回归模型分析2组患者术前相关指标、结石资料、麻醉及复苏情况等。结果术前中段尿培养阳性及肌酐异常、结石大小、结石类型,以及术中低血压、低血压持续时间、补液量是PCNL后发生SIRS的独立危险因素(优势比=3. 834、2. 271、1. 458、1. 381、3. 331、2. 683、1. 653,95%可信区间:1. 921～5. 882、1. 434～4. 912、1. 012～3. 323、1. 132～3. 011、1. 732～5. 877、1. 812～3. 981、1. 331～2. 111,P <0. 05)。结论术前中段尿培养阳性及肌酐异常、结石大小、结石类型,以及术中低血压、低血压持续时间、补液量是PCNL后SIRS的高危因素,需重视围手术期麻醉相关因素的监测与管理。Objective To analyze the anesthesia related risk factors for systemic inflammatory response syndrome(SIRS)after percutaneous nephrolithotomy(PCNL)retrospectively,in order to provide a scientific basis for the prevention and treatment of SIRS after PCNL.Methods A total of 643 patients with renal calculi treated with PCNL in the Urologic Surgery Department of Sichuan Provincial People′s Hospital from January 2015 to June 2017 were selected and divided into the SIRS group(89 cases)and non-SIRS group(554 cases)according to the SIRS diagnostic criteria.The preoperative related indexes,stone data,anesthesia and resuscitation situation in the two groups were analyzed by adopting the logisitic regression model.Results Preoperative midstream urine culture positive,abnormal creatinine level,stone size,stone type,intraoperative hypotension,hypotension duration and intraoperative infused fluid volume were the independent risk factor of postoperative SIRS occurrence(OR=3.834,2.271,1.458,1.381,3.331,2.683,1.653,95%CI:1.921-5.882,1.434-4.912,1.012-3.323,1.132-3.011,1.732-5.877,1.812-3.981,1.331-2.111,P<0.05).Conclusion Preoperative midstream urinary culture positive,creatinine abnormality,stone size,stone type,intraoperative hypotension,hypotension duration and intraoperative fluid supplement volume are the high risk factors of SIRS after PCNL.It is needed to pay attention to monitoring and management of the anesthesia related factors in perioperative period.

关 键 词：肾石病/外科学 肾造口术 经皮/副作用 全身炎症反应综合征 麻醉 危险因素 

分 类 号：R692.4[医药卫生—泌尿科学] R614.2[医药卫生—外科学]