小儿泌尿系结石术后尿脓毒血症风险因素的分析  

Risk factors of urinary sepsis after operation for urolithiasis in children

作　　者：雍江[1] 覃锋 赵夭望[1] 孙小文 刘畅 刘广蔚 李创业 李艳芳[1] Yong Jiang;Qin Feng;Zhao Yaowang;Sun Xiaowen;Liu Chang;Liu Guangwei;Li Chuangye;Li Yanfang(Department of Pediatric Urology,Hunan Children's Hospital,Changsha 410007,China)

机构地区：[1]湖南省儿童医院泌尿外科,长沙410007

出　　处：《中华小儿外科杂志》2024年第9期827-832,共6页Chinese Journal of Pediatric Surgery

基　　金：湖南省儿童泌尿生殖疾病临床医学研究中心(2021SK4017)。

摘　　要：目的:探讨小儿泌尿系结石术后尿脓毒血症的风险因素。方法:分析湖南省儿童医院泌尿外科2011年1月至2023年6月因小儿泌尿系结石住院手术治疗的574例患儿的临床资料,其中男389例,女185例;年龄范围在4~218个月。收集患儿尿常规、血常规、细菌类型、影像学检查情况、手术方式等资料。根据术后是否发生尿脓毒血症,将患儿分为尿脓毒血症组和非尿脓毒血症组。组间差异比较采用Dunnett-t检验、Kruskal-Wallis秩和检验,采用二元logistic回归多因素分析术后尿脓毒血症的独立风险因素。结果:574例患儿中,156例尿培养检出细菌,以革兰氏阴性菌最为多见(65.4%,102/156),细菌类型主要为大肠埃希菌(26.9%,42/156)和粪肠球菌(19.9%,31/156)。所有患儿均行手术治疗,分期手术313例,术后发生尿脓毒血症16例,非尿脓毒血症558例。二元logistic回归多因素分析结果显示,分期手术(OR=20.209,95%CI 1.330~307.019,P=0.030);术前尿常规细菌数(OR=1.000,95%CI 1.000~1.000,P<0.001);术后尿常规白细胞数(OR=1.000,95%CI 1.000~1.001,P=0.030);术后血常规中性粒细胞数(OR=1.160,95%CI 1.004~1.340,P=0.044),CT肾周渗出征象(OR=0.053,95%CI 0.004~0.063,P=0.020)是影响术后尿脓毒血症的独立风险因素。结论:分期手术、术前尿常规细菌数、术后尿常规白细胞数、术后血常规中性粒细胞数、CT肾周渗出征象为小儿泌尿系结石术后尿脓毒血症的风险因素。建议使用有效的抗菌药物等积极干预,减少术后尿脓毒血症的发生。Objective:To explore the risk factors of urinary sepsis after urolithiasis operation in children.Methods:From January 2011 to June 2023,the relevant clinical data were retrospectively reviewed for 574 hospitalized urolithiasis children.There were 389 boys and 185 girls with an age range of(4-218)months.The results of urine routine,blood routine,bacterial typing,imaging examinations and operative approaches were recorded.According to the presence or absence of postoperative urinary sepsis,they were assigned into two groups of urinary sepsis(n=16)and non-urinary sepsis(n=558).Dunnett-t and Kruskal-Wallis rank-sum tests were utilized for comparing the differences between groups.And multivariate Logistic regression was utilized for examining the independent risk factors of postoperative urinary sepsis.Results:Among them,156 cases were detected by urine culture,among which Gram-negative bacteria were the most common(65.4%,102/156)and the dominant types of bacteria were Escherichia coli(26.9%,42/156)and Enterococcus faecalis(19.9%,31/156).All children were operated and 313 cases by stages.Multivariate Logistic regression analysis indicated that operation by stages(OR=20.209,95%CI 1.330-307.019,P=0.030),preoperative count of routine bacteria in urine(OR=1.000,95%CI 1.000-1.000,P<0.001),postoperative count of routine neutrophil in urine(OR=1.000,95%CI 1.000-1.001,P=0.030),postoperative count of neutrophil in blood(OR=1.160,95%CI 1.004-1.340,P=0.044)and signs of perirenal exudation on computed tomography(CT)(OR=0.053,95%CI 0.004-0.063,P=0.020)were independent risk factors for postoperative urinary sepsis.Conclusions:Staged operation,preoperative routine urine bacterial count,postoperative count of urine neutrophil,postoperative count of blood neutrophil and CT signs of perirenal exudation are the risk factors for postoperative urinary sepsis in urolithiasis children.Effective antibiotics drugs and other active interventions are recommended for lowering the postoperative occurrence of urinary sepsis.

关 键 词：泌尿系疾病 结石 儿童 尿脓毒血症 风险因素 

分 类 号：R726.9[医药卫生—儿科]