上尿路结石梗阻并发尿脓毒症的特点及急诊处理策略  

Characters and emergency treatment of upper urinary tract stone obstruction complicated with urosepsis

作　　者：赵磊[1] 王伟[1] 王建忠[1] 樊松[1] 郝宗耀[1] 梁朝朝[1] Zhao Lei;Wang Wei;Wang Jianzhong;Fan Song;Hao Zongyao;Liang Chaozhao(Department of Urology,the First Affiliated Hospital of Anhui Medical University,Hefei 230021,China)

机构地区：[1]安徽医科大学第一附属医院泌尿外科,合肥230021

出　　处：《中华泌尿外科杂志》2021年第7期507-512,共6页Chinese Journal of Urology

摘　　要：目的探讨上尿路结石梗阻并发尿脓毒症的特点及急诊处理策略。方法回顾性分析安徽医科大学第一附属医院2018年1月至2019年12月收治的28例因上尿路结石致尿脓毒症患者的临床资料。男6例,女22例;中位年龄54(32~93)岁。均有发热,中位病程3(1~14)d,体温38.5~41.0℃。患者急诊入院时收缩压76~138 mmHg(1mmHg=0.133kPa),将收缩压<90 mmHg的患者定义为低血压组;收缩压≥90 mmHg者定义为正常血压组。低血压组12例,男3例,女9例;年龄中位值57(32~93)岁;左侧结石7例,右侧5例;结石位于输尿管上段5例、中段2例、下段4例,肾结石1例;结石长径中位值10(6~20)mm;合并糖尿病6例,神经系统疾病1例,近期有体外冲击波碎石术(ESWL)史3例。正常血压组16例,男3例,女13例;年龄中位值53(33~76)岁;左侧结石5例,右侧9例,双侧2例;结石位于输尿管上段10例、中段4例、下段2例;结石长径中位值10(8~14)mm;合并神经系统疾病3例,近期有ESWL史3例。两组年龄、性别、结石侧别、结石大小、结石位置的差异均无统计学意义(P>0.05),两组合并糖尿病比例的差异有统计学意义(P=0.024)。两组患者均急诊查血常规、C反应蛋白(CRP)、降钙素原等,行血、尿细菌培养,评估序贯器官衰竭(SOFA)评分,同时予经验性应用抗菌药物治疗,低血压者予扩容,扩容后血压仍低时加用血管活性药物。血压稳定后行集合系统减压治疗。比较两组感染指标及治疗方法的差异。结果低血压组与正常血压组的白细胞[16.34(2.55~41.65)×10^(9)/L与13.97(6.23~26.65)×10^(9)/L,P=0.577]、CRP[143.0(74.2~200.0)ng/ml与110.0(22.7~200.0)ng/ml,P=0.771]差异无统计学意义。低血压组与正常血压组的血小板[65.5(14.0~170.0)×10^(9)/L与73.0(17.0~412.0)×10^(9)/L,P=0.030]、降钙素原[95.5(26.5~200.0)ng/ml与57.6(1.0~200.0)ng/ml,P=0.040]差异均有统计学意义。低血压组与正常血压组SOFA评分[8.5(3.0~13.0)分与5.0(2.0~8.0)分,P=0.001]差异Objective To investigate the characters and emergency treatment strategy of upper urinary tract stone obstruction complicated with urosepsis.Methods Clinical data of 28 cases of urosepsis,caused by upper urinary tract stone obstruction and arranged for emergency admission in our hospital during January 2018 to December 2019,were retrospectively analyzed.There were 6 males and 22 females.The median age was 54(32-93)years old.All patients had fever with the temperature ranged from 38.5 to 41.0℃.The median course of disease was 3(ranging 1-14)days.The systolic blood pressure ranged from 76 to 138 mmHg at admission.Hypotension group was defined as the systolic blood pressure<90 mmHg after admission.Normotensive group was defined as the systolic blood pressure≥90 mmHg.There were 12 cases in hypotension group,including 3 males and 9 females.The median age was 57(ranging 32-93)years old.The stones located at left side in 7 cases and right side in 5 cases.The stones located at the upper ureter in 5 cases,middle ureter in 2 cases,lower ureter in 4 cases and renal calculi in one case.The median length of the stone was 10(ranging 6-20)mm.Six cases suffered with diabetes mellitus.One case suffered with neuron system disease.3 cases have history of recent extracorporeal shock wave lithotripsy(ESWL).There were 16 cases in normotensive group,including 3 males and 13 females with the median age of 53(ranging 33-76)years old.The stones located at left side in 5 cases,right side in 9 cases and bilateral in 2 cases.The stones located at the upper ureter in 10 cases,middle ureter in 4 cases,lower ureter in 2 cases.The length of the stone was 10(ranging 8-14)mm.There were 3 cases with neurological diseases and 3 cases with recent ESWL history.There was significant difference between hypotension group and normotensive group in ration of diabetes mellitus(P=0.024).Blood routine examination,C-reactive protein(CRP),procalcitonin(PCT),blood and urine bacterial culture were performed in both groups.The patients were treated with empiri

关 键 词：尿路结石 尿脓毒症 特点 急诊治疗 

分 类 号：R691.4[医药卫生—泌尿科学] R692.5[医药卫生—外科学]