PCNL术后并发尿脓毒血症的相关因素及治疗分析(修改稿).do.docVIP

PCNL术后并发尿脓毒血症的相关因素及防治分析 葛卫军[1] 杨华伟[1] 谢晓[1] (湖南中医药大学第一附属医院泌尿外科，湖南 长沙,410007) 摘要 目的 探讨经皮肾镜取石(PCNL)术后尿脓毒血症的原因及防治策略。方法 回顾性分析1260例PCNL患者的临床资料。结果 1260例患者术后发生尿脓毒血症24例。其中结石直径2cm、鹿角形结石、术前有尿路感染、手术时间60min、术中灌注泵压力120mmHg组的发生率均高于对照组。组间比较差异均有统计学意义（P0.05）。24例患者均经抗感染、扩容等治疗后治愈。结论 结石体积大、鹿角形肾结石、术前合并尿路感染、手术时间长、灌注泵压力高是PCNL术后尿脓毒血症的危险因子。抗生素及扩容是其治疗的关键。 关键词 经皮肾镜取石术 肾结石 尿脓毒血症 治疗 Urosepsis after percutaneous nephrolithotomy: risk factors ,prophylaxis and management GE WeiJun YANG Huawei XIE Xiao Department of urology,The First Hospital of Hunan University of Chinese Medicine ChangSha 410007 [Abstract] Objective To analyze the risk factors of urosepsis after percutaneous nephrolithotomy(PCNL) and to explore the prophylaxis policy and management. Methods The clinical data of 1260 cases who underwent PCNL from 2005 to 2013 were analyzed retrospectively. The risk factors were analyzed. Result Of 1260 Patients ,24 developed urosepsis after PCNL.The post-operative urosepsis rate in patients with stone diameter2cm,deerhorn stone, preoperative infection in urinary tract perative time60min,irrigation pump pressure120mmHg,was higher than that in control group. respectively.There were significant differences between each group.all 24 patients were cured successfully .conclusions The risk factors of urosepsis after PCNL arelarger stone size ,deerhorn stone,preoperative infection in urinary tract,longer operative time and higher irrigation pressure.The key of successful treatment is early use of antibiotics,anti-shock,and effective drainage. [key words] Percutaneous nephrolithotomy ; Renal calculus; urosepsis; therapy 经皮肾镜取石术因其微创、恢复快等优点，目前已成为上尿路结石的主要治疗方式。但仍有出血、结石残留、术后感染等并发症的可能。其中术后早期发生的尿脓毒血症是其最严重的并发症之一。我院2005年10月～2013年10月间有1260例因上尿路结石行PCNL的患者，术后发生尿脓毒血症者有24例。通过总结这些患者的临床资料，分析导致术后发生尿脓毒血症的相关因素及治疗方法，探讨其防治策略，现报告如下。 资料与方法 1．1 一般资料 全部1260例患者均为我院泌尿外科2005年10月～2013年10月期间的上尿路结石住院病人，男性751例，女性509例。年龄15～80岁。平均年龄为45岁。其中肾结石1020例，输尿管上段结石175例，输尿管结石合并肾结石105例，结石最大径0.8～5.0cm，平均2.5cm。合并中度以上肾积水103