經(jīng)皮腎鏡碎石取石術(shù)后尿膿毒血癥的相關(guān)因素

鄧月云+李秀寧

[摘要]目的 探討經(jīng)皮腎鏡碎石取石術(shù)（PCNL）后尿膿毒血癥的相關(guān)因素。方法 收集2013年3月～2016年4月云浮市人民醫(yī)院456例行PCNL的患者，術(shù)后出現(xiàn)尿膿毒血癥28例，對(duì)這些病例的年齡、性別、尿白細(xì)胞、血白細(xì)胞、術(shù)前尿培養(yǎng)、腎功能、結(jié)石大小、腎積液、手術(shù)史、出血量及手術(shù)時(shí)間等因素進(jìn)行分組比較，并對(duì)其中有統(tǒng)計(jì)學(xué)差異的因素進(jìn)行Logistic回歸分析，得到PCNL術(shù)后尿膿毒血癥的相關(guān)因素。結(jié)果 尿白細(xì)胞、術(shù)前尿培養(yǎng)、腎功能、結(jié)石大小、腎積液、手術(shù)史、術(shù)中出血量及手術(shù)時(shí)間的不同分組比較，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）?；貧w分析發(fā)現(xiàn)尿培養(yǎng)、腎功能、結(jié)石大小、手術(shù)史及手術(shù)時(shí)間與PCNL術(shù)后尿膿毒血癥相關(guān)。結(jié)論 術(shù)前針對(duì)尿培養(yǎng)陽(yáng)性、腎功能損害、結(jié)石較大、有泌尿系手術(shù)史及估計(jì)手術(shù)時(shí)間長(zhǎng)的這些因素進(jìn)行處理和評(píng)估，有望預(yù)防和降低術(shù)后尿膿毒血癥的發(fā)生。

[關(guān)鍵詞]經(jīng)皮腎鏡碎石取石術(shù)；尿膿毒血癥；相關(guān)因素

[中圖分類(lèi)號(hào)] R699 [文獻(xiàn)標(biāo)識(shí)碼] A [文章編號(hào)] 1674-4721（2016）12（c）-0051-03

Related factor of urinary sepsis after percutaneous nephrolithotomy

DENG Yue-yun LI Xiu-ning

Department of Urology，People′s Hospital of Yunfu City in Guangdong Province，Yunfu 527300，China

[Abstract]Objective To explore related factor of urinary sepsis after percutaneous nephrolithotomy （PCNL）.Methods 45 patients who conducted PCNL in People′s Hospital of Yunfu City from March 2013 to April 2016 were collected.Postoperative urinary sepsis in 28 cases，factors of age，sex，urine white blood cell，blood white blood cells，preoperative urine culture，renal function，renal stone size，renal effusion，surgery history，bleeding volume and operation time were group compared，and Logistic regression analysis was performed on the factors which were statistically different to get related factors of urinary sepsis after PCNL.Results Comparison different groups of urine white blood cell，preoperative urine culture，renal function，renal stone size，renal effusion，surgery history，intraoperative bleeding volume and operation time，the difference was statistically significant （P<0.05）.Logistic regression analysis found that urine culture，renal function，renal stone size，operation history and operation time were related to urinary sepsis after PCNL.Conclusion Aim at processing and evaluation the factors of positive urine culture，renal injury，larger renal stones，surgery history of urinary tract，ecaluation of longer operation time before operation are expected to prevent and reduce occurrence rate of urinary sepsis after PCNL.

[Key words]Percutaneous nephrolithotomy；Urinary sepsis；Related factor

經(jīng)皮腎鏡碎石取石術(shù)（percutaneous nephrolithotomy，PCNL）在處理上尿路結(jié)石具有明顯優(yōu)勢(shì)，特別是>2 cm的結(jié)石，以創(chuàng)傷小、術(shù)后恢復(fù)快使其成為該類(lèi)型結(jié)石的主要術(shù)式[1-2]。但該術(shù)式也有一定的并發(fā)癥，如腎實(shí)質(zhì)出血、腎周臟器損傷、尿路感染和腎功能損害等[3]。術(shù)后尿路感染可進(jìn)展為尿膿毒血癥，雖然發(fā)生率不高，但可引起嚴(yán)重后果，處理較為棘手[4]。因此，筆者分析與PCNL術(shù)后尿膿毒血癥的相關(guān)因素，有的放矢地預(yù)防，以期降低與手術(shù)相關(guān)的尿膿毒血癥的發(fā)生率。

1資料與方法

1.1一般資料

收集2013年3月～2016年4月云浮市人民醫(yī)院行B超引導(dǎo)下PCNL的病例，均有完整的病歷資料可查，由同一術(shù)者主刀。共納入病例456例次，右腎169例次，左腎287例次，雙側(cè)32例；2次手術(shù)的有22例；年齡24～78歲，平均49歲；平均手術(shù)出血量（72.36±35.48）ml；平均手術(shù)時(shí)間（93.59±20.08）min。術(shù)后共有28例出現(xiàn)尿膿毒血癥。對(duì)研究中涉及的因素進(jìn)行分組：年齡根據(jù)均值分組；性別分男、女兩組；尿白細(xì)胞分為>2+組和≤2+組；血白細(xì)胞分為>10×109/L組和≤10×109/L組；術(shù)前尿培養(yǎng)分為陽(yáng)性組和陰性組；腎功能根據(jù)肌酐值分為升高組和正常組；結(jié)石大小根據(jù)直徑分為>2 cm和≤2 cm組；腎積液中，分為無(wú)積液和輕度積液、中重度積液兩組；根據(jù)術(shù)前有無(wú)泌尿系手術(shù)史分兩組；術(shù)中出血量和手術(shù)時(shí)間根據(jù)均值分組。