糖尿病患者经皮肾镜取石术后发生全身炎症反应综合征的危险因素分析

发布时间：2018-05-19 17:32

本文选题：肾造口术 + 经皮　；参考：《北京大学学报(医学版)》2016年04期

【摘要】：目的:分析合并糖尿病的尿路结石患者在经皮肾镜取石(percutaneous nephrolithotomy,PCNL)术后发生全身炎症反应综合征(systemic inflammatory response syndrome,SIRS)的可能危险因素。方法:回顾北京大学人民医院泌尿外科2006年6月至2015年12月期间,因尿路结石行PCNL术且术前诊断为2型糖尿病的患者资料,分析患者的临床特征与术后SIRS之间的相关性。符合条件的患者共461例,其中男性281例,女性180例,平均年龄57岁,术后137例(29.7%)患者出现SIRS。根据术后是否发生SIRS,将患者分为两组,比较两组患者的各项临床参数的差异。结果:与未发生SIRS的患者组相比,发生SIRS的患者组术前白细胞计数(×109/L)更高[7.76(4.00~17.96)vs.6.31(2.00~17.40),P0.001];术前血糖(mmol/L)更高[7.30(3.08~19.90)vs.6.40(3.42~16.78),P0.001];手术时间(min)更长[75(20~270)vs.60(20~200),P0.001];相应的住院时间(d)也更长[12(2~46)vs.11(3~29),P=0.019]。术前血糖偏高的患者术后SIRS的发生率高于术前血糖控制在正常范围内的患者[35.1%(100/285)vs.21.0%(37/176),P=0.001];鹿角形结石的患者术后SIRS的发生率高于非鹿角形结石的患者[38.8%(33/85)vs.27.7%(104/376),P=0.042];术前合并尿路感染的患者术后SIRS的发生率高于无感染患者[36.8%(50/136)vs.26.6%(81/304),P=0.032];两组间年龄、性别、体重指数(body mass index,BMI)、术前血红蛋白水平、是否输血、手术时间与术后SIRS发生率的差异无统计学意义。多因素Logistic回归分析结果显示,术后SIRS发生与患者的性别、术前是否合并尿路感染以及是否为鹿角形结石无显著相关性,而与术前白细胞计数高于正常(OR=3.194,95%CI:1.531~6.666,P=0.002)、手术时间大于60 min(OR=1.635,95%CI:1.088~2.456,P=0.018)以及术前血糖水平有显著相关性,术前血糖控制在正常值范围内(3.3~6.1 mmol/L)的患者与术前血糖7.1 mmol/L的患者相比,PCNL术后SIRS的发生率差异有统计学意义。结论:对于合并2型糖尿病的尿路结石患者,PCNL术后SIRS的发生与患者术前白细胞水平、手术时间、术前空腹血糖水平存在显著相关性。术前白细胞计数升高、手术时间大于60 min、术前空腹血糖较高的患者PCNL术后发生SIRS的风险增加。
[Abstract]:Objective: to analyze the risk factors of systemic inflammatory response syndrome (systemic inflammatory response syndrome) after percutaneous nephrolithotomy in patients with diabetes mellitus. Methods: from June 2006 to December 2015, the data of patients with type 2 diabetes mellitus diagnosed as type 2 diabetes mellitus by PCNL for urinary calculi were reviewed, and the correlation between clinical features and postoperative SIRS was analyzed. There were 461 eligible patients, including 281 males and 180 females with an average age of 57 years. Patients were divided into two groups according to the occurrence of SIRS. the differences of clinical parameters between the two groups were compared. Results: the preoperative white blood cell count (脳 109 / L) was higher in the patients with SIRS than that in the patients without SIRS [7.764.004.0017.96v s.6.312.000.17.4040P0.001], and the preoperative blood glucose levels were higher (7.30v 3.0819.90vs.6.403.42tir 16.78p0.001); the operative time was longer (7520270vs.602020200); and the corresponding hospitalization time was longer (12246vs.1132929P0.019). The incidence of postoperative SIRS in patients with hyperglycemia before operation was higher than that in patients with normal blood glucose control before operation [35.1b / 100 / 285v s.21.0 / 37 / 176 / P0.001]; the incidence of postoperative SIRS in patients with staghorn calculi was higher than that in patients with non-staghorn calculi [38.8v 33 / 85vs.27.774 / 376P0.042]; the patients with urinary tract infection before operation had a higher incidence of SIRS than those with non-staghorn calculi (38.8v 33 / 85vs.27.774 / 376P0.042); the incidence of postoperative SIRS in patients with staghorn calculi was higher than that in patients with non-staghorn stones. The incidence of SIRS in patients after operation was higher than that in patients without infection [36.8 / 136vs.26.6]. Gender, body mass index, hemoglobin level before operation, blood transfusion, operation time and postoperative SIRS incidence were not significantly different. The results of multivariate Logistic regression analysis showed that there was no significant correlation between the occurrence of SIRS and gender, preoperative urinary tract infection and staghorn calculi. There was a significant correlation between the white blood cell count before operation and the preoperative blood glucose level. The white blood cell count was higher than that before operation (3.194 ~ 95 CI: 1.531C: 6.666P: 0.002), and the operation time was more than 60 min. The mean time of operation was 1.63595% (CI: 1.0882.456C 0.018) and the level of blood glucose before operation was significantly correlated. The incidence of SIRS after PCNL was significantly higher in patients with preoperative blood glucose within normal range of 3.3 卤6.1 mmol / L than in patients with preoperative glucose of 7.1 mmol/L. Conclusion: the incidence of SIRS in patients with urinary calculi complicated with type 2 diabetes mellitus has a significant correlation with preoperative leukocyte level, operation time and fasting blood glucose level. The preoperative leukocyte count was increased and the operation time was longer than 60 min. The risk of SIRS in patients with high fasting blood glucose was increased after PCNL.
【作者单位】：北京大学人民医院泌尿外科;
【分类号】：R699

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