标准通道经皮肾镜碎石术治疗结石性脓肾术后发生SIRS的相关因素分析

发布时间：2018-03-17 16:49

本文选题：肾结石　切入点：脓肾经皮肾镜全身炎症反应综合征危险因素　出处：《四川大学学报(医学版)》2017年05期 　论文类型：期刊论文

【摘要】：目的分析结石性脓肾患者感染特点和经皮肾镜碎石术(percutaneous nephrolithotomy,PCNL)后发生全身炎症反应综合征(systemic inflammatory respo-nse syndrome,SIRS)的相关危险因素。方法回顾性分析我院2011年1月至2015年12月收治的所有术前7d无发热的结石性脓肾患者PCNL手术资料。统计并分析患者术前尿培养常见病原菌的种类特点、比例和耐药性。同时用多因素logistic回归分析患者年龄、性别、术前尿培养、术前抗生素使用≥3d、鹿角形结石、手术时间等14个因素对患者术后SIRS的影响。结果共纳入69例结石性脓肾患者,术前尿培养共分离出47株病原菌,以大肠埃希菌(30例)、奇异变形杆菌(8例)等革兰阴性杆菌(G-杆菌)为主。多数G-杆菌主要对头霉素类、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦及碳青霉烯类等药物敏感。术后21例(30.4%)患者发生SIRS,多因素logistic回归显示:手术时间≥60min[标准偏回归系数(Beta)=0.378,比值比(OR)=4.483,95%可信区间(CI)1.111~18.100,P=0.035]为结石性脓肾PCNL术后发生SIRS的独立危险因素,术前使用抗生素≥3d(Beta=-0.450,OR=0.194,95%CI 0.051~0.741,P=0.017)和术前使用敏感抗菌药物(Beta=-0.610,OR=0.102,95%CI0.017~0.602,P=0.012)两个因素能降低SIRS的发生。一期手术与二期手术两组患者的清石率及术后发生SIRS、出血等相关并发症发生率的差异无统计学意义。二期手术可降低术后住院时间(P=0.047),但总住院时间较一期组延长(P0.001)。结论结石性脓肾患者术前尿培养病原菌以G-杆菌为主,且耐药率高。一期PCNL治疗结石性脓肾安全有效,减少手术时间并术前使用敏感抗菌药物治疗≥3d可有效降低SIRS发生风险。
[Abstract]:Objective to analyze the characteristics of infection in patients with calculous pyonephrosis and percutaneous nephrolithotomy (percutaneous nephrolithotomy, PCNL) after the occurrence of systemic inflammatory response syndrome (systemic inflammatory respo-nse syndrome, SIRS) and the related risk factors. Methods a retrospective analysis of all patients with 7d without fever in our hospital from January 2011 to December 2015 were the patients with calculous pyonephrosis the PCNL operation data. And statistical analysis of preoperative urine culture characteristics of pathogenic bacteria and drug resistance. At the same time, the proportion of using multivariate logistic regression analysis with age, gender, preoperative urine culture, the use of antibiotics was 3D before surgery, staghorn calculi, operation time and the influence of 14 factors on SIRS patients after the results of the 69 cases of calculous pyonephrosis were included with preoperative urine cultures were isolated 47 strains of pathogenic bacteria, Escherichia coli (30 cases), Proteus mirabilis (8 cases) and gram negative bacilli ( G-). The majority of G- coli bacilli cephamycins, piperacillin / tazobactam, Cefoperazone / sulbactam and carbapenem sensitive drug. 21 cases after surgery (30.4%) patients with SIRS, multi factor Logistic regression analysis showed that: the operation time was more than 60min[standard partial regression coefficient (Beta) =0.378, the odds ratio (OR) =4.483,95% confidence interval (CI) 1.111~18.100, P=0.035] as independent risk factors for calculous pyonephrosis after PCNL SIRS, the use of antibiotics before surgery (Beta=-0.450 = 3D, OR=0.194,95%CI 0.051~0.741, P=0.017) and preoperative use of antibiotics (Beta=-0.610, OR=0.102,95%CI0.017~0.602, P=0.012) two factors can be reduced the occurrence of SIRS. SIRS and stone clearance rate of one stage surgery and two stage operation of the two groups of patients, bleeding and other complications related to the difference was not statistically significant. The two stage operation can reduce the postoperative hospitalization time (P=0.047), but The total hospitalization time over a period of Yanchang Formation (P0.001). Conclusion calculous pyonephrosis patients urine culture pathogenic bacteria in G- bacteria, and the resistance rate is high. A period of PCNL in the treatment of calculous pyonephrosis is safe and effective, reduce the operation time and preoperative use of sensitive antimicrobial agents than 3D can effectively reduce the occurrence of SIRS the risk.

【作者单位】：四川大学华西医院泌尿外科;
【分类号】：R699

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