经皮肾造瘘术在合并血小板减少的尿源性脓毒血症治疗中的应用  

A study of percutaneous nephrostomy in the treatment of urogenic sepsis with thrombocytopenia

作　　者：江新哲 余勇军 JIANG Xinzhe;YU Yongjun(Medical College,Wuhan University of Science and Technology,Wuhan 430081,China;不详)

机构地区：[1]武汉科技大学医学院,430081 [2]武汉科技大学附属孝感医院、孝感市中心医院泌尿外科

出　　处：《临床外科杂志》2024年第2期140-143,共4页Journal of Clinical Surgery

摘　　要：目的 研究经皮肾造瘘术在合并血小板减少的梗阻性尿源性脓毒血症治疗中的安全性和有效性。方法 2017年10月~2021年5月我院收治的合并血小板减少的尿源性脓毒血症病人116例,合并肾功能指标异常者23例(血肌酐>500 mmol/L)。术前行泌尿系CT或超声等检查明确肾积水。依据术前血常规中血小板的数量分为研究组(血小板<50×10^(9)/L)和对照组(血小板≥50×10^(9)/L)。两组病人均在超声引导下进行经皮肾造瘘术。观察两组手术成功率、体温、血常规白细胞计数及降钙素原恢复正常的时间、术后大出血、休克、副损伤出现情况。结果 研究组病人的术前发热时间为(6.9±2.2)天、血小板计数为(35±10.2)×10^(9)/L、术前降钙素原(PCT)为(36±6.2)ng/ml、血肌酐升高占比30%,对照组分别为(4.2±2.0)天、(115±58.9)×10^(9)/L、(20±2.6)ng/ml和12%,两组比较差异有统计学意义(P<0.05)。研究组和对照组PCT恢复时间分别为(6.9±2.8)天、(4.8±1.5)天;体温正常恢复时间分别为(36.2±3.5)小时、(28.5±2.3)小时;白细胞计数恢复时间分别为(5.3±1.2)天、(3.2±2.5)天;血小板恢复时间分别为(6.0±2.3)天、(3.5±2.0)天,两组比较,差异有统计学意义。两组手术成功率、术后副损伤、大出血、休克等并发症比较,差异无统计学意义(P>0.05)。结论 经皮肾造瘘治疗合并血小板减少的尿源性脓毒血症有效、安全。Objective To investigate the safety and effectiveness of percutaneous nephrostomy in the treatment of obstructive urinogenic sepsis complicated with thrombocytopenia.Methods Clinical data of 116 patients with urogenic sepsis complicated with thrombocytopenia admitted to Xiaogan Hospital of Wuhan University of Science and Technology from October 2017 to May 2021 were collected.There were 23 patients with abnormal renal function indexes(serum creatinine>500 mmol/L).Preoperative urinary tract CT or ultrasound were performed to confirm hydronephrosis.According to the number of platelets in preoperative blood routine,they were divided into study group(platelet<50×10^(9)/L)and control group(platelet≥50×10^(9)/L).Percutaneous nephrostomy was performed under ultrasound guidance in both groups.The outcome indexes included the success rate of operation,body temperature,routine white blood cell count,the time to return to normal of procalcitonin,postoperative bleeding,shock,and side injury.Results In the study group,preoperative fever time was(6.9±2.2)days,platelet count was(35±10.2)×10^(9)/L,preoperative procalcitonin(PCT)was(36±6.2)ng/ml,and serum creatinine increased by 30%.While,the data in control group were(4.2+2.0)days,(115±58.9)×10^(9)/L,(20±2.6)ng/ml and 12%,respectively.The difference between the two groups was statistically significant(P<0.05).The recovery time of PCT in study group and control group was(6.9±2.8)days and(4.8±1.5)days,respectively.The normal recovery time of body temperature was(36.2±3.5)hours and(28.5±2.3)hours,respectively.The recovery time of white blood cell count was(5.3±1.2)days and(3.2±2.5)days,respectively.The recovery time of platelet was(6.0±2.3)days and(3.5±2.0)days,respectively.The difference between the two groups was statistically significant(P<0.05).There was no significant difference in surgical success rate,postoperative collateral injury,massive hemorrhage,shock and other complications between the two groups(P>0.05).Conclusion Percutaneous nephrostomy(PCN)is ef

关 键 词：输尿管梗阻 尿源性脓毒血症 经皮肾造瘘术 血小板减少 

分 类 号：R699.2[医药卫生—泌尿科学]