经皮肾镜碎石术后急性肾损伤的危险因素分析及防治  

Risk factors for acute kidney injury after percutaneous nephrolithotomy and related prevention and treatment measures

作　　者：张爱平 罗生军[1] 周江涛 李东阳 刘航[1] Zhang Aiping;Luo Shengjun;Zhou Jiangtao;Li Dongyang;Liu Hang(Department of Urology,The First Affiliated Hospital of Chongqing Medical University)

机构地区：[1]重庆医科大学附属第一医院泌尿外科,重庆400016

出　　处：《重庆医科大学学报》2025年第2期191-197,共7页Journal of Chongqing Medical University

摘　　要：目的:调查经皮肾镜碎石术(percutaneous nephrolithotomy,PCNL)后急性肾损伤(acute kidney injury,AKI)的发病率,分析影响PCNL术后AKI发生的危险因素,并提出防治方法。方法:回顾性分析重庆医科大学附属第一医院泌尿外科2014年1月至2022年10月接受PCNL患者的临床资料,根据患者术后血肌酐上升水平,将研究对象分为AKI组和非AKI组,采用单因素及多因素logistic分析PCNL术后出现AKI的危险因素。结果:共纳入628例患者,PCNL术后出现AKI有43例,发病率约为6.8%(43/628)。单因素分析结果显示,与非AKI组患者相比,AKI组患者的平均年龄、术前血肌酐、血尿酸、尿白细胞计数更高,肾积水程度更严重,术前血红蛋白水平更低,AKI组中术前尿培养阳性、肾萎缩、双侧上尿路结石、鹿角形结石、结石伴脓苔、术后尿脓毒血症、术后输血患者比例更高(P<0.05)。将单因素分析有差异的指标纳入多因素logistic回归分析,结果表明,患者年龄增加(OR=1.043)、术前肾功能不全(OR=1.021),双侧上尿路结石(OR=3.582)、鹿角形结石(OR=3.590)、术后尿脓毒血症(OR=5.543)是PCNL术后发生急性肾损伤的独立危险因素。结论:本中心患者PCNL术后AKI的发病率为6.8%,年龄增加、术前肾功能不全、双侧上尿路结石、鹿角形结石、术后尿脓毒血症是PCNL术后急性肾损伤的独立危险因素,临床上应重视上述危险因素并积极预防术后急性肾损伤的发生。Objective:To investigate the incidence rate of acute kidney injury(AKI)after percutaneous nephrolithotomy(PCNL),analyze the risk factors for AKI after PCNL,and propose related prevention and treatment measures.Methods:A retrospective analysis was performed for the clinical data of the patients who underwent PCNL in Department of Urology,The First Affiliated Hospital of Chongqing Medical University,from January 2014 to October 2022,and according to the increase in the level of serum creatinine after surgery,the patients were divided into AKI group and non-AKI group.Univariate and multivariate logistic regression analyses were used to investigate the risk factors for AKI after PCNL.Results:A total of 628 patients were included in the study,among whom 43 developed AKI after PCNL,resulting in an incidence rate of 6.8%(43/628).The univariate analysis showed that compared with the non-AKI group,the AKI group had significantly higher mean age,preoperative serum creatinine,serum uric acid,and urine white blood cell count,a significantly higher severity of hydronephrosis,a significantly lower level of hemoglobin before surgery,and a significantly higher proportion of patients with positive urine culture before surgery,renal atrophy,bilateral upper urinary tract calculi,stag-horn calculi,calculi with pyuria,postoperative urosepsis,and postoperative transfusion(P<0.05).The statistically significant indicators identified by the univariate analysis were included in the multivariate logistic regression analysis,and the results showed that the increase in the age of the patient(odds ratio[OR]=1.043),preoperative renal insufficiency(OR=1.021),bilateral upper urinary tract calculi(OR=3.582),stag-horn calculi(OR=3.590),and postoperative urosepsis(OR=5.543)were independent risk factors for AKI after PCNL.Conclusion:The incidence rate of AKI after PCNL is 6.8%in our center.The increase in age,preoperative renal insufficiency,bilateral upper urinary tract calculi,stag-horn calculi,and postoperative urosepsis are independent risk fact

关 键 词：经皮肾镜碎石术 急性肾损伤 危险因素 

分 类 号：R692.4[医药卫生—泌尿科学]