经输尿管气压弹道碎石术后260例合并重症感染患者的早期诊疗分析

发布时间：2018-05-06 18:14

本文选题：输尿管气压弹道碎石术 + 重症感染　；参考：《中华医院感染学杂志》2017年09期

【摘要】：目的探讨经输尿管气压弹道碎石术后合并重症感染的早期诊疗方法,以减少经输尿管气压弹道碎石术后合并重症感染的发生。方法选择2012年1月-2015年12月收治的260例经输尿管气压弹道碎石术后合并重症感染患者为研究对象(观察组),另选同期经输尿管气压弹道碎石术后未发生感染的患者260例(对照组),比较两组患者的结石直径、尿液检查情况、术前感染情况、输尿管镜操作时间、手术时间、术中出血、术中灌注压、术后引流、碎石成功率及结石清除率。结果观察组术前结石15mm和尿液检查呈阳性的患者(207例、215例)多于对照组(32例、39例),差异有统计学意义(P0.05);观察组术前感染未控制和术后引流不畅的患者(195例、179例)多于对照组(14例、27例),差异有统计学意义(P0.05);观察组手术时间、输尿管镜操作时间[(72.19±14.31)min、(72.07±16.11)min]多于对照组[(65.14±12.01)min、(35.53±14.21)min],观察组术中出血量[(24.65±3.27)ml]多于对照组[(18.21±2.32)ml],观察组术中灌注压[(81.28±7.01)mmHg]高于对照组[(65.42±6.73)mmHg],差异有统计学意义(P0.05);观察组患者碎石成功率和结石排除率(77.31%、70.00%)均低于对照组(88.85%、82.31%),差异均有统计学意义(P0.05)。结论结石直径较大、尿检阳性、术前感染未控制、手术时间过长、输尿管镜操作时间、术中出血量过多、术中灌注压过高、术后引流不畅易导致输尿管气压弹道碎石术后合并重症感染发生,在早期诊断和治疗过程中应给予有效的抗感染治疗,提高碎石技巧以及加强术后护理。
[Abstract]:Objective to explore the early diagnosis and treatment of severe infection after transureteral pneumatic lithotripsy, so as to reduce the incidence of severe infection after transureteral pneumatic lithotripsy. Methods 260 patients with severe infection after ureteral pneumatic lithotripsy from January 2012 to December 2015 were selected as study subjects (observation group, no infection after ureteral pneumatic lithotripsy during the same period). The diameter of calculi in the two groups was compared with that in the control group (n = 260). Urine examination, preoperative infection, ureteroscope operation time, operative time, intraoperative bleeding, intraoperative perfusion pressure, postoperative drainage, lithotripsy success rate and stone removal rate. Results the number of patients with positive 15mm and urine examination before operation in the observation group was more than that in the control group (39 cases), the difference was statistically significant (P 0.05), and in the observation group, there were 195 cases (179 cases) with uncontrolled infection before operation and poor drainage after operation. There were more than 14 cases in the control group and 27 cases in the control group, the difference was statistically significant (P 0.05), the time of operation in the observation group was less than that in the control group. The operative time of ureteroscopy [72.19 卤14.31 16.11)min] was longer than that of control group [65.14 卤12.01 min], the intraoperative bleeding volume in observation group [24.65 卤3.27)ml] was longer than that in control group [18.21 卤2.32)ml], the intraoperative perfusion pressure in observation group [81.28 卤7.01)mmHg] was higher than that in control group [65.42 卤6.73)mmHg], the difference was statistically significant (P 0.05), the success rate of lithotripsy and stone removal in observation group was higher than that in control group (P 0.05). 77.31% (P 0.05) were lower than the control group (88.85%, 82.31%), and the difference was statistically significant (P 0.05). Conclusion the stone diameter is larger, urine test is positive, infection before operation is not controlled, operation time is too long, operative time of ureteroscope, blood loss during operation is too much, perfusion pressure is too high during operation. Postoperative drainage is easy to lead to severe infection after ureteral pneumatic lithotripsy. In the early diagnosis and treatment, effective anti-infection treatment should be given, lithotripsy skills should be improved and postoperative nursing should be strengthened.
【作者单位】：江汉大学附属医院泌尿外科;
【基金】：湖北省卫生厅基金资助项目(WX16E07)
【分类号】：R699.4

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