妇科肿瘤患者输尿管支架相关性尿脓毒血症的危险因素及防治  

Investigation of risk factors and prevention strategies of ureteral stents-associated urosepsis in patients with gynecological tumors

作　　者：郑丹[1] 田小燕[1] 孙玉菡[2] 代玲 王柯静[1] Zheng Dan;Tian Xiaoyan;Sun Yuhan(Department of Pharmacy,Women and Children’s Hospital of Chongqing Medical University,Chongqing Health Center for Women and Chidren,Chongqing 401147;Department of Obstetrics and Gynecology,Women and Children’s Hospital of Chongqing Medical University,Chongqing Health Center for Women and Chidren,Chongqing 401147)

机构地区：[1]重庆医科大学附属妇女儿童医院,重庆市妇幼保健院药学部,重庆401147 [2]重庆医科大学附属妇女儿童医院,重庆市妇幼保健院妇产科,重庆401147

出　　处：《现代妇产科进展》2022年第8期579-583,共5页Progress in Obstetrics and Gynecology

基　　金：重庆市卫生健康委医学科研项目(No:2022WSJK003)。

摘　　要：目的:探讨妇科肿瘤患者留置输尿管支架相关性尿脓毒血症的危险因素及防治策略,为非泌尿外科发生尿脓毒血症的防治提供思路。方法:回顾分析2017年1月至2020年12月在重庆市妇幼保健院行妇科肿瘤手术安置并取出输尿管支架的176例患者的资料,根据是否发生尿脓毒血症将患者分为脓毒血症组和非脓毒血症组,对尿脓毒血症的相关因素进行分析。结果:176例患者中发生尿脓毒血症者53例(30.11%)。单因素分析显示,患者术前白蛋白和血红蛋白水平,尿亚硝酸盐和尿培养阳性,留置支架期间行辅助放化疗、发生尿路感染、导尿管脱管困难以及留置支架时间与尿脓毒血症密切相关,差异有统计学意义(P<0.05)。多因素logistic回归分析显示,留置输尿管支架时间(OR=2.306,95%CI为1.036~5.133)、严重贫血(OR=2.663,95%CI为1.082~6.556)、低蛋白血症(OR=2.616,95%CI为1.181~5.793)、尿亚硝酸盐阳性(OR=4.656,95%CI为1.968~11.013)、留置支架期间放化疗(OR=2.419,95%CI为1.087~5.385)及发生症状性尿路感染(OR=3.097,95%CI为1.399~6.855)为独立危险因素。多重耐药肠杆菌科细菌是主要的致病菌,对一、二代头孢菌素和氟喹诺酮类药物耐药率较高。结论:应严格评估留置支架指征,尽量减少支架留置时间;取出支架前严格评估尿脓毒血症危险因素,积极治疗有症状尿路感染,提高无症状菌尿的筛查意识,围手术期采取抗菌药物分层防治策略。Objective:To explore the risk factors and preventive strategies of ureteral stents-related urosepsis in patients with gynecological malignant tumors,and provide ideas for the prevention and treatment of urosepsis which occurs in non-urological ward.Methods:Retrospective study was conducted based on the medical records of 176 patients with gynecologic malignant tumors who underwent surgery for placement and removal of ureteral stents in our hospital from January 2017 to December 2020.The patients were divided into two groups according to the presence or absence of urosepsis,and the factors related to urinary sepsis were analyzed.Results:Among 176 patients,53(30.11%)patients had urosepsis.By univariate analysis,preoperative levels of albumin,hemoglobin,the positive results of urinary nitrite,urine culture results,adjuvant radiotherapy and(or)chemotherapy,difficulty of catheter detachment,urinary tract infection during indwelling stent and the length of indwelling ureteral stent were closely related to urosepsis,and the differences were statistically significant(P<0.05).Multivariate logistic regression analysis showed that there were independent risk factors including the time of indwelling ureteral sten(OR=2.306,95%CI:1.036~5.133),severe anemia(OR=2.663,95%CI:1.082~6.556),hypoproteinemia(OR=2.616,95%CI:1.181~5.793),the positive results of urinary nitrite(OR=4.656,95%CI:1.968~11.013),radiotherapy and(or)chemotherapy(OR=2.419,95%CI:1.087~5.385),and symptomatic urinary tract infection during indwelling stent(OR=3.097,95%CI:1.399~6.855).Multidrug-resistant enterobacteriaceae bacteria were the main pathogens of urosepsis which were highly resistant were highly to first and second-generation cephalosporins and fluoroquinolones.Conclusions:The indication of indwelling stent should be strictly evaluated and the length of days the stents retained be minimized.Before the stent is taken out,the risk factors of urosepsis should be strictly assessed.The symptomatic urinary tract infection should be actively treated,and the awar

关 键 词：妇科肿瘤 输尿管支架 尿脓毒血症 危险因素 防治策略 

分 类 号：R737.33[医药卫生—肿瘤]