经皮肾镜碎石术后发生全身炎症反应综合征的影响因素分析

发布时间：2018-09-08 14:17

【摘要】：目的探讨经皮肾镜碎石术(percutaneous nephrolithotomy,PCNL)术后发生全身炎症反应综合征(systemic inflammatory response syndrome,SIRS)的危险因素,以便更好地预防临床中PCNL术后SIRS的发生。方法收集山东大学齐鲁医院泌尿外科2014年1月—2016年10月收治的泌尿系结石并行PCNL的患者信息。根据术后是否发生SIRS分为SIRS组和非SIRS组。分析比较2组患者间性别、年龄、糖尿病史、手术时间、结石大小、单发或多发结石、肾积水和术前尿培养结果与术后SIRS的相关性,探讨SIRS的危险因素。统计分析采用描述性统计分析、单因素分析(卡方分析、独立样本t检验)和多因素Logistic回归分析。结果本研究共入选190例患者,术后SIRS共发生40例(21.1%)。单因素分析的结果显示,糖尿病史(p=0.023)、手术时间(p=0.034)、结石大小(p0.001)和术前尿培养(p0.001)与PCNL术后SIRS发生之间显著相关,患者性别、年龄、单发或多发结石、是否合并肾积水与PCNL术后SIRS发生无明显相关性(p0.05)。纳入糖尿病史、手术时间、结石大小和术前尿培养4个因素的logistic回归中,糖尿病史和结石大小是SIRS的独立危险因素。ROC曲线显示结石大小和糖尿病史两因素具有一定的联合预测价值(AUC=0.743,95%CI:0.653-0.833)。结论PCNL术后SIRS的发生与患者有无糖尿病及结石大小有密切关系,需引起泌尿外科医生高度重视。
[Abstract]:Objective to investigate the risk factors of systemic inflammatory response syndrome (systemic inflammatory response syndrome,SIRS) after percutaneous nephrolithotripsy (percutaneous nephrolithotomy,PCNL) in order to prevent SIRS after PCNL. Methods data of patients with urinary calculi treated with PCNL from January 2014 to October 2016 in Qilu Hospital of Shandong University were collected. SIRS was divided into SIRS group and non-SIRS group according to whether it occurred or not. Sex, age, history of diabetes, operation time, stone size, single or multiple stones, hydronephrosis and urine culture before and after SIRS were analyzed and compared between the two groups, and the risk factors of SIRS were discussed. Descriptive statistical analysis, single factor analysis (chi-square analysis, independent sample t-test) and multivariate Logistic regression analysis were used in the statistical analysis. Results of 190 patients, 40 (21. 1%) had SIRS after operation. Univariate analysis showed that the history of diabetes mellitus (p0.023), operative time (p0.034), stone size (p0.001) and preoperative urine culture (p0.001) were significantly correlated with the occurrence of SIRS after PCNL. There was no significant correlation between hydronephrosis and SIRS after PCNL (p0.05). The history of diabetes, the time of operation, the size of stone and the urine culture before operation were included in logistic regression. Diabetes history and stone size were independent risk factors of SIRS. ROC curve showed that both stone size and diabetes history had combined predictive value (AUC=0.743,95%CI:0.653-0.833). Conclusion the incidence of SIRS after PCNL is closely related to diabetes mellitus and stone size, which should be paid more attention to by urologers.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R699

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