快速序贯器官衰竭评分对经皮肾镜取石术后脓毒症休克的预测价值  

The predictive value of the quick sequential organ failure assessment score in septic shock after percutaneous nephrolithotomy

作　　者：徐宏博[1] 魏雪栋[2] 胡林昆[2] 陆兵[1] 袁和兴[2] 黄玉华[2] 侯建全[1] Xu Hongbo;Wei Xuedong;Hu Linkun;Lu Bing;Yuan Hexing;Huang Yuhua;Hou Jianquan(Department of Urology,Dushu Lake Hospital Affiliated to Soochow University,Dushu Lake Branch of First Affiliated Hospital of Soochow University,Suzhou 215000,China;Department of Urology,First Affiliated Hospital of Soochow University,Suzhou 215006,China)

机构地区：[1]苏州大学附属独墅湖医院,苏州大学附属第一医院独墅湖院区泌尿外科,215000 [2]苏州大学附属第一医院泌尿外科,215006

出　　处：《中华泌尿外科杂志》2021年第5期332-338,共7页Chinese Journal of Urology

摘　　要：目的探讨快速序贯器官衰竭评分(qSOFA)对经皮肾镜取石术(PCNL)后脓毒症休克的预测价值。方法回顾性分析2018年5月至2019年10月苏州大学附属第一医院收治的309例肾结石行PCNL患者的临床资料。男192例,女117例;年龄(51.4±12.8)岁;伴高血压病82例,糖尿病23例;78例既往有泌尿系手术史;88例术前尿细菌培养阳性。102例经腹部CT和腹部X线平片(KUB)诊断为鹿角形结石。309例术中8例(2.6%)采用多通道。术后24 h对所有患者进行qSOFA和全身炎症反应综合征(SIRS)评分,将qSOFA≥2分和SIRS评分≥2分作为诊断脓毒症休克的阳性标准。绘制受试者工作特征(ROC)曲线,比较qSOFA、SIRS评分对脓毒症休克的诊断价值。应用单因素logistic回归筛选出PCNL术后发生脓毒症的相关危险因素,并纳入多因素logistic回归进行校正,应用校正后的多因素logistic回归分析两种评分标准对PCNL术后相关临床结局指标(术后住院时间、术后输血、术后再干预、结石残留、30 d内计划再入院例数、30 d内非计划再入院例数)的预测价值。结果本研究309例的中位手术时间为85(56,115)min。309例中,23例(7.4%)术后符合qSOFA阳性,84例(27.2%)符合SIRS评分阳性。7例(2.3%)术后进入ICU并诊断为脓毒症休克,其中6例qSOFA、SIRS评分均阳性,1例qSOFA、SIRS评分均为阴性。术后结石成分分析结果显示64例(20.7%)为感染性结石。术后复查KUB显示179例(57.9%)存在结石残留。术后中位住院时间为7(6,9)d。10例(3.2%)术后行输血治疗。9例(2.9%)术后进行再干预治疗。30 d内计划、非计划再入院例数分别为41例(13.3%)和16例(5.2%)。ROC曲线显示qSOFA和SIRS评分的曲线下面积(AUC)分别为0.900和0.799。qSOFA诊断脓毒症休克的特异性、阳性似然比、阳性预测值均明显高于SIRS评分[94.4%(285/302)与74.2%(224/302),15.23与3.32,26.1%(6/23)与7.1%(6/84),均P<0.001],差异有统计学意义。qSOFA和SIRS评分的敏感性�Objective To evaluate the predictive value of the quick sequential organ failure assessment(qSOFA)score in septic shock after percutaneous nephrolithotomy(PCNL).Methods 309 patients who underwent PCNL at the First Affiliated Hospital of Soochow University between May 2018 and October 2019 were retrospectively reviewed.Among them,there were 192 men and 117 women,whose mean age was(51.4±12.8)years(range from 20 to 79 years).There were 82 cases(26.5%)of hypertension and 23 cases(7.4%)of diabetes.There were 88 patients(28.5%)with positive preoperative urine culture.102 patients(33.0%)were diagnosed with staghorn calculi by abdominal CT and urinary tract abdominal plain film(KUB).78 patients(25.2%)had a history of urinary surgery.The qSOFA and SIRS were evaluated to all patients within 24 h after PCNL and the best diagnostic criteria was considered as qSOFA≥2 and SIRS≥2.Receiver operating characteristic(ROC)curves were constructed and the areas under the curve(AUC)were calculated to compare the discriminatory ability of qSOFA and SIRS with the post-PCNL septic shock.A univariate logistic regression analysis was used to identify the covariates associated with post-PCNL sepsis.Then adjusted multivariate analysis was used to identify the predictive value of positive qSOFA and SIRS for the postoperative clinical outcomes including postoperative hospitalization days,postoperative blood transfusion,postoperative re-intervention,residual stone,planned readmission within 30 days and unplanned readmission within 30 days.Results Among the 309 patients who underwent PCNL,23 patients(7.4%)met the positive qSOFA criterion while 84 patients(27.2%)developed to SIRS.7 patients(2.3%)were admitted to ICU after operation and were eventually diagnosed as septic shock,among which 6 patients met the criteria of qSOFA and SIRS.8 patients(2.6%)underwent multi-channel operation.The median operative time of 309 patients was 85(56,115)min.Postoperative calculus composition analysis showed that 64 patients(20.7%)were infectious calculi.Post

关 键 词：肾结石 经皮肾镜取石术 快速序贯器官衰竭评分 全身炎症反应综合征 脓毒症休克 

分 类 号：R459.7[医药卫生—急诊医学] R699.2[医药卫生—治疗学]