输尿管软镜碎石术治疗上尿路结石后尿脓毒症风险的多因素分析  

Multi-factor analysis of risk factors for urosepsis after flexible ureteroscope lithotripsy for upper urinary calculi

作　　者：吴春磊[1] 李泽宇 马阔 刘沛[1] Wu Chunlei;Li Zeyu;Ma Kuo;Liu Pei(Department of Urology Surgery,First Affiliated Hospital of Xinxiang Medical University,Weihui 453100,Henan,China)

机构地区：[1]新乡医学院第一附属医院泌尿外科,河南卫辉453100

出　　处：《右江民族医学院学报》2020年第2期207-211,共5页Journal of Youjiang Medical University for Nationalities

基　　金：新乡医学院第一附属医院博士科研启动基金(xyyfy2014BS-003)。

摘　　要：目的探讨输尿管软镜联合钬激光碎石术治疗上尿路结石术后发生尿脓毒症的危险因素。方法回顾性分析2016年1月—2018年12月于我院行输尿管软镜碎石的219例患者资料,使用快速序贯器官衰竭评分评价尿脓毒症,根据术后是否出现尿脓毒血症将患者分为两组,使用二元Logistic回归分析术后尿脓毒症的危险因素。结果输尿管软镜碎石后出现尿脓毒症的发生率为9.59%(21例)。单变量的Logistic回归显示糖尿病史(OR=3.27,P=0.030),结石体积(OR=1.35,P=0.007),未预留置输尿管支架(OR=4.51,P=0.010),未使用输尿管软镜鞘(OR=4.00,P=0.020),手术时间(OR=1.10,P<0.001),尿细菌培养阳性(OR=4.07,P=0.005),尿培养为多重耐药菌(multidrug-resistant organism,MDRO)(OR=15.15,P<0.001)是导致术后尿脓毒症的风险。进行多变量综合调整后,未预留置输尿管支架(OR=6.20,P=0.010),未使用输尿管软镜鞘(OR=7.66,P=0.009),手术时间(OR=1.13,P=0.003),尿细菌培养阳性(OR=3.95,P=0.010),尿培养为MDRO(OR=28.55,P=0.001)仍是导致术后尿脓毒症的独立危险因素。结论未预留置输尿管支架、未使用输尿管软镜鞘、手术时间过长、尿细菌培养阳性(特别是MDRO)是导致输尿管软镜碎石术后发生尿脓毒症的独立危险因素。Objective To analyze the risk factors for postoperative urosepsis in patients undergoing flexible ureteroscope combined with holmium laser lithotripsy for upper urinary calculi.Methods Data of 219 patients undergone flexible ureteroscope lithotripsy for upper urinary calculi in our department from January 2016 to December 2018 was analyzed retrospectively.Quick sequential organ failure assessment(qSOFA)was used to evaluate urosepsis,and the patients were divided into two groups according to whether the patients had postoperative urosepsis or not.The risk factors for postoperative urosepsis were evaluated by binary logistic regression analysis.Results The incidence of urosepsis was 9.59%(21 cases)after flexible ureteroscope lithotripsy.Single variable Logistic regression analysis identified a history of diabetes(OR=3.27,P=0.030),stone volume(OR=1.35,P=0.007),no prior indwelling of ureteral stent(OR=4.51,P=0.010),no use of flexible ureteroscope sheath(OR=4.00,P=0.020),operative time(OR=1.10,P<0.001),positive bacterial cultures of urine(OR=4.07,P=0.005),MDRO(multidrug-resistant organism)in urine culture(OR=15.15,P<0.001)as risk factors for postoperative urosepsis.After multivariable comprehensive adjustment,no prior indwelling of ureteral stent(OR=6.20,P=0.010),no use of flexible ureteroscope sheath(OR=7.66,P=0.009),operation time(OR=1.13,P=0.003),positive bacterial cultures of urine(OR=3.95,P=0.010),positive MDRO urine culture(OR=28.55,P=0.001)were independent risk factors for postoperative urosepsis.Conclusion No prior indwelling of ureteral stent,no use of flexible ureteroscope sheath,prolonged operation time,positive urine bacterial culture(especially MDRO)would be independent risk factors for predicting urosepsis complications after flexible ureteroscope lithotripsy.

关 键 词：输尿管软镜钬激光碎石术 尿脓毒症 快速序贯器官衰竭评分 LOGISTIC回归分析 危险因素 

分 类 号：R699[医药卫生—泌尿科学]