输尿管软镜碎石术并发尿脓毒血症风险评估系统的构建及临床应用价值  

Construction and clinical application of a risk assessment system for retrograde intrarenal surgery complicated with urosepsis

作　　者：王光宇 刘玉明[2] Wang Guangyu;Liu Yuming(Graduate School of Hunan University of Chinese Medicine,Changsha 410000,China;Department of Urology,Changsha Central Hospital Affiliated to University of South China,Changsha 410000,China)

机构地区：[1]湖南中医药大学研究生院,长沙410000 [2]南华大学附属长沙中心医院泌尿外科,长沙410000

出　　处：《国际泌尿系统杂志》2024年第1期82-88,共7页International Journal of Urology and Nephrology

基　　金：湖南省卫生健康委科研计划课题(20201964)。

摘　　要：目的建立输尿管软镜碎石术(RIRS)的风险评估系统, 以评估术后并发尿脓毒血症的风险。方法选取2021年10月至2022年2月于长沙市中心医院行RIRS治疗的244例患者的临床资料。检索国内外有关RIRS术后并发尿脓毒血症危险因素的文献, 检索时间为建库至2021年12月, 收集检索文献中接受RIRS患者的病例数据, 运用Meta分析筛选RIRS并发尿脓毒血症的危险因素, 构建RIRS术后并发尿脓毒血症风险评估系统(FURSS), 运用受试者工作特征(ROC)曲线验证评估系统的临床应用价值。结果筛选出7个危险因素[性别(女性)、手术时间≥60 min、糖尿病、术前尿培养阳性、结石长径≥1 cm、感染性结石、脓尿]与RIRS术后并发尿脓毒血症的风险相关。根据尿脓毒血症诊断标准, 术后发生尿脓毒血症的比率约为5.3%(13/244)。根据风险评分系统对所收集病例进行评分, 术前评分>6.5分的患者45例, 其中11例患者术后发生尿脓毒血症。ROC曲线下面积为0.890(95%CI:0.818~0.963, P<0.001), 当评分为6.5分时, 约登指数最大, 敏感性为84.6%, 特异性为85.3%。结论 FURSS对RIRS术后引发尿脓毒血症有较好预测价值, 当患者术前综合评分>6.5分时, 术后并发尿脓毒血症的风险较高。Objective To establish a risk assessment system for retrograde intrarenal surgery to assess the risk of postoperative complications of urosepsis.Methods The clinical data of 244 patients who underwent RIRS treatment in Changsha Central Hospital from October 2021 to February 2022 were selected.The literature on the risk factors of urosepsis complicated by RIRS was searched at home and abroad,and the search time was from the establishment of the database to December 2021,the case data of patients receiving RIRS in the retrieval literature were collected,the risk factors of urosepsis complicated by RIRS were screened by Meta-analysis,the risk assessment system for urosepsis complicated by RIRS was constructed(FURSS)after RIRS,and the clinical application value of the evaluation system was verified by using the receiver operating characteristic(ROC)curve.Results Seven risk factors[gender(female),operation time≥60 min,diabetes,positive preoperative urine culture,stone diameter≥1 cm,infectious stones and pyuria]were associated with the risk of urosepsis after RIRS.According to the diagnostic criteria for urosepsis,the rate of postoperative urosepsis was approximately 5.3%(13/244).According to the risk scoring system,45 patients with preoperative score>6.5 scores,of which 11 patients developed postoperative urosepsis.The area under the ROC curve was 0.890(95%CI:0.818-0.963,P<0.001),and when the score was 6.5 scores,the Youden index was the highest,with a sensitivity of 84.6%and a specificity of 85.3%.Conclusions The FURSS established in this institute has good predictive value for the postoperative triggering of urosepsis in RIRS,and when the patient's preoperative comprehensive score is greater than 6.5 scores,the risk of postoperative urosepsis is higher.

关 键 词：肾结石 输尿管结石 输尿管软镜碎石术 尿源性脓毒症 

分 类 号：R699[医药卫生—泌尿科学]