PCNL术后并发尿脓毒血症的相关因素及治疗分析2.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 探讨经皮肾镜碎石取石(PCNL)术后尿脓毒血症的原因及防治策略。方法 回顾性分析2005年～2013年间1260例行PCNL患者的临床资料，分析其结石大小、结石形状、术前感染情况、手术时间、术中灌注压力等相关因素对术后尿脓毒血症的影响。结果 1260例行PCNL患者，术后发生尿脓毒血症者为24例。其中结石直径2cm组术后尿脓毒血症者发生率为2.6%，结石直径≤2cm组为1.0%；鹿角形结石组为3.8%，非鹿角形结石为2.0%；手术时间60min组术后尿脓毒血症者发生率为2.7%，手术时间≤60min组为1.5%；术中灌注泵压力120mmHg组发生率为2.9%，灌注泵压力≤120mmHg组为1.2%。组间尿脓毒血症发生率比较差异均有统计学意义（P0.05）。确诊为尿脓毒血症患者均经抗感染、扩容抗休克等治疗后治愈，体温、血常规正常，未遗留器官功能损害。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、术中灌注泵压力高是导致PCNL术后尿脓毒血症的危险因子。早期足量有效抗生素的应用、积极扩容抗休克、保护脏器功能、术后通畅引流是治疗PCNL术后尿脓毒血症的关键。 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 such as stone size, stone shape,Hydronephrosis condition, operative time,and irragation pump pressure were analyzed. Result Of 1260 Patients ,24 developed urosepsis after PCNL.The post-operative urosepsis rate in patients with stone diameter2cm(2.6%),deerhorn stone(3.8%),operative time60min(2.7%),irrigation pump pressure120mmHg(2.9%),was higher than the patients with stone diameter ≤2cm(1.0%),non-deerhorn stone(2.0%),operative time ≤ 60min(1.5%),irrigation pump pressure≤ 120mmHg(1.2%),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. [