输尿管软镜碎石术后感染并发尿源性脓毒症的影响因素分析  

Influencing factors for postoperative urine-induced sepsis in flexible ureteroscope lithotripsy patients

作　　者：丁俊 周晨曦[2] 李国波[2] 陈国栋[2] 朱旭明[2] 刘俊强[2] 孙建鸣 崔飞伦 DING Jun;ZHOU Chen-xi;LI Guo-bo;CHEN Guo-dong;ZHU Xu-ming;LIU Jun-qiang;SUN Jian-ming;CUI Fei-lun(Jiangsu University Medical School,Zhenjiang,Jiangsu 212013,China)

机构地区：[1]江苏大学医学院泌尿外科,江苏镇江212013 [2]解放军第101医院泌尿外科,江苏无锡214000 [3]镇江市第一人民医院泌尿外科,江苏镇江212000

出　　处：《中华医院感染学杂志》2019年第14期2134-2137,2142,共5页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金资助项目(81372742)

摘　　要：目的探讨输尿管软镜碎石术后感染并发尿源性脓毒症的影响因素。方法采用分层整群抽样回顾分析的方法,选择2013年3月-2018年4月医院行输尿管软镜碎石术治疗452例肾结石患者,根据术后感染及合并尿源性脓毒症情况,将407例未发生尿源性脓毒症患者设为对照组,45例发生尿源性脓毒症患者设为研究组,仔细阅览其病历资料,记录患者基本情况、术前检查结果、手术情况等,分析输尿管软镜碎石术后发生尿源性脓毒症的影响因素。结果研究组45例患者感染类型主要包括消化系统感染、呼吸系统感染、泌尿系统感染及血液系统感染;经单因素与多项Logistic逐步回归分析发现:结石直径>1.5 cm、手术时间>60 min、术前尿培养阳性、合并糖尿病可能是术后感染发生尿源性脓毒症的影响因素。结论结石负荷大、手术时间长、术前尿培养阳性、合并糖尿病可能是导致输尿管软镜碎石术后发生尿源性脓毒症的影响因素,临床应重视对患者进行术前评估,对于合并上述风险者,应尽早给予干预,减少或避免尿源性脓毒症的发生。OBJECTIVE To explore the influencing g factors for postoperative urine-induced sepsis in patients undergoing flexible ureteroscope lithotripsy. METHODS By means of retrospective analysis of stratified cluster sampling, 452 patients with kidney stone who received the flexible ureteroscope lithotripsy from Mar 2013 to Apr 2018 were enrolled in the study. According to the status of postoperative urine-induced sepsis, 407 patients who did not have urine-induced sepsis were assigned as the control group, and 45 patients who had urine-induced sepsis were set as the control group. The medical records of the patients were reviewed, the baseline data, results of preoperative examinations and surgical indexes were recorded, and the influencing factors for the postoperative urine-induced sepsis in the flexible ureteroscope lithotripsy patients were observed. RESULTS The patients who had digestive system infection, respiratory system infection, urinary system infection and blood system infection were dominant among the 45 patients with postoperative infection in the study group. Univariate analysis and multivariate logistic stepwise regression analysis showed that the diameter of stone more than 1.5 cm, operation duration more than 60 min, positive preoperative urine culture, and complication with diabetes mellitus were the influencing factors for the postoperative urine-induced sepsis in the flexible ureteroscope lithotripsy patients. CONCLUSION Heavy stone load, long operation duration, positive preoperative urine culture and complication with diabetes mellitus are the influencing factors for the postoperative urine-induced sepsis in the flexible ureteroscope lithotripsy patients. It is necessary for the hospital to focus on the preoperative assessment and take the interventions as early as possible so as to prevent the urine induced sepsis.

关 键 词：尿源性脓毒症 输尿管软镜碎石术 感染 影响因素 

分 类 号：R691.3[医药卫生—泌尿科学]