经皮肾镜碎石取石术后发生全身炎症反应综合征的多因素分析

发布时间：2018-01-30 08:46

本文关键词： 经皮肾镜碎石取石术全身炎症反应综合征中性粒细胞淋巴细胞单核细胞　出处：《中国微创外科杂志》2017年11期 　论文类型：期刊论文

【摘要】：目的探讨外周血炎性指标与经皮肾镜碎石取石(percutaneous nephrolithotomy,PCNL)术后发生全身炎症反应综合征(systemic inflammation response syndrome,SIRS)的关系。方法回顾性分析2015年1月~2016年6月我科175例PCNL的临床资料,其中术后发生SIRS 52例(SIRS+组),未发生SIRS 123例(SIRS-组)。采用logistic回归分析PCNL术后发生SIRS的预后因素。外周血炎性指标包括中性粒细胞/淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)、中性粒细胞/单核细胞比值(neutrophil to monocyte ratio,NMR)、术后NLR/术前NLR(NLR比值)和术后NMR/术前NMR(NMR比值)。其他研究指标包括年龄、性别、ASA分级、是否有同侧结石手术史、是否术前留置双J管或肾造瘘管、术前血肌酐、术前尿培养是否阳性、手术时间、是否多通道、是否同期行输尿管镜操作、术中是否出现心动过速和术后是否输血等。结果单因素分析显示术后即刻外周血炎性指标升高、女性、术前尿培养阳性、多通道手术、手术时间长和术后输血与术后SIRS的发生相关(P0.05)。多因素logistic回归分析显示NMR比值是PCNL术后发生SIRS的独立预后因素,将NMR比值根据四分位数分为4组,Q50~Q75组和Q75组发生SIRS的风险是Q25组的6.5倍和8.5倍(OR=6.534,95%CI:1.031~41.429,P=0.046;OR=8.591,95%CI:1.095~67.422,P=0.041)。结论术后即刻外周血炎性指标、性别、术前尿培养是否阳性、是否多通道手术、手术时间、术后是否输血与PCNL术后SIRS的发生相关,其中NMR比值是PCNL术后发生SIRS的独立预后因素。
[Abstract]:Objective to investigate the relationship between peripheral blood inflammatory index and percutaneous nephrolithotomy with percutaneous nephrolithotripsy. The systemic inflammatory response syndrome (inflammation response syndrome) occurred after PCNL. Methods the clinical data of 175 cases of PCNL from January 2015 to June 2016 in our department were analyzed retrospectively. 52 cases of SIRS occurred after operation in Sirs group. No SIRS in 123 cases of SIRS- group). Logistic regression analysis was used to analyze the prognostic factors of SIRS after PCNL. The peripheral blood inflammatory markers included neutrophil / lymphocyte ratio (P < 0.05). Neutrophil to lymphocyte ratio. The ratio of neutrophil to monocyte / monocyte was NMRs. The ratio of postoperative NLR / preoperative NLR(NLR) and postoperative NMRs / preoperative NMR(NMR ratio were measured. Other parameters included age, sex, and history of operation for ipsilateral calculi. Whether to place double J tube or nephrostomy tube before operation, serum creatinine before operation, positive urine culture before operation, operation time, multichannel, and ureteroscope operation at the same time. Results univariate analysis showed that the peripheral blood inflammatory index increased immediately after operation, female, urine culture positive before operation, multi-channel operation. Long operation time and postoperative blood transfusion were associated with postoperative SIRS (P0.05). Multivariate logistic regression analysis showed that NMR ratio was an independent prognostic factor for SIRS after PCNL. NMR ratio was divided into 4 groups according to quartile. The risk of developing SIRS in Q50 Q75 group and Q75 group was 6.5 times and 8.5 times higher than that in Q25 group. 95 CI: 1.031, 41.429, Pu 0.046; Conclusion Peripheral blood inflammatory markers, sex and urine culture were positive or not immediately after operation. Whether multichannel operation, time of operation, blood transfusion after operation is related to the occurrence of SIRS after PCNL, the ratio of NMR is an independent prognostic factor of SIRS after PCNL.
【作者单位】：北京大学人民医院泌尿外科;北京大学应用碎石技术研究所;
【分类号】：R699.2
【正文快照】： *通讯作者,E-mail:huang6299@sina.comoperation time,number of access,and blood transfusion are correlated with occurrence of SIRS after PCNL.Post NMR/pre NMR is anindependent prognostic factor for the occurrence of SIRS after PCNL.经皮肾镜碎石取石术(percut

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