尿路感染对URSL术后并发症的影响研究分析

发布时间：2018-11-15 19:51

【摘要】：目的：主要探讨尿路感染对URSL术后并发症（发热，出血，脓毒血症，肾功能损害）的影响，进一步指导临床医生对此类患者围手术期的治疗。方法：本文回顾性分析2011年12月～2012年12月我院收治的输尿管结石患者214例，其中选择行经尿道输尿管镜气压弹道碎石术治疗的有178例患者，严格按照术前是否尿路感染作为分组标准，分为尿路感染组和无尿路感染组,分别对各组是否发热、出血、出现脓毒血症、出现肾功能损害病例数进行统计学分析研究。结果:尿路感染组62例,无尿路感染组116例,术前尿路感染组中术后发热者48例,不发热者14例,发热者占尿路感染组的77.4%；无尿路感染组术后发热者6例,不发热者110例，发热者占非尿路感染组的5.2%；卡方分析显示p=0.0000.05,表明尿路感染与术后发热有明显关系。术前尿路感染组中术后出现肉眼血尿者58例,无血尿者4例,出血病例数占到93.5%；无尿路感染组术后出现肉眼血尿者73例,无血尿者43例，出血病例占到62.9%；卡方分析显示p=0.0010.05,表明尿路感染与术后肉眼血尿有直接关系。术前尿路感染组中术后出现肾功能异常者22例,无肾功能异常者40例,出现肾功能损害病例数占尿路感染组总病例数的35.5%；无尿路感染组术后出现肾功能异常者18例,无肾功能异常者98例，出现肾功能损害病例数占非尿路感染组总病例数的15.5%，；卡方分析显示p=0.0020.05,表明尿路感染与会影响到术后患者肾功能。术前尿路感染组中术后出现脓毒血症者4例,未出现者58例,出现脓毒血症病例数占尿路感染组的6.5%；无尿路感染组术后出现脓毒血症者2例,未出现者114例，出现脓毒血症病例数占非尿路感染组的1.7%；卡方分析显示p=0.0330.05,表明尿路感染与术后尿毒症的出现有显著关系。结论:术前尿路感染与经尿道输尿管镜术后并发症发热、肉眼血尿、脓毒血症、肾功能异常有直接关系。故行输尿管镜手术前，患者需行尿常规和血常规检查，若患者合并感染，，先经验用药抗感染治疗，后积极行中段尿细菌培养和药物敏感试验，明确细菌及敏感药物后，予以抗感染治疗，复查尿常规，直至患者无尿路感染，以此减少患者术后并发症的发生。
[Abstract]:Objective: to investigate the effect of urinary tract infection on postoperative complications (fever, hemorrhage, sepsis, renal dysfunction) after URSL, and to guide clinicians in the perioperative treatment of these patients. Methods: 214 cases of ureteral calculi treated in our hospital from December 2011 to December 2012 were retrospectively analyzed. 178 cases were treated with transurethral ureteroscopic pneumatic lithotripsy. According to the criteria of urinary tract infection before operation, it was divided into urinary tract infection group and no urinary tract infection group. The number of cases of fever, hemorrhage, sepsis and renal function damage in each group were analyzed statistically. Results: there were 62 cases of urinary tract infection group and 116 cases of no urinary tract infection group. 48 cases of postoperative fever and 14 cases of non-febrile infection were found in pre-operation and post-operation group. The patients with fever accounted for 77.4% of the urinary tract infection group. In the non-urinary tract infection group, there were 6 cases of postoperative fever, 110 cases of no fever, and 5.2% of the non-urinary tract infection group, the chi-square analysis showed that there was a significant relationship between urinary tract infection and postoperative fever. There were 58 cases of naked hematuria, 4 cases of no hematuria, and 93 5 cases of hemorrhage, 73 cases of naked hematuria and 43 cases of no hematuria occurred after operation in the group of infection of urinary tract before and after operation, and the cases of bleeding accounted for 62.9%. Chi-square analysis showed that there was a direct relationship between urinary tract infection and naked hematuria after operation. There were 22 cases of abnormal renal function and 40 cases of no abnormal renal function in the pre-operation and post-operation group. The number of cases with renal function damage accounted for 35.5B in the total cases of urinary tract infection group. In the non-urinary tract infection group, there were 18 cases of abnormal renal function and 98 cases of no abnormal renal function. The number of cases with renal function damage accounted for 15.5% of the total cases of non-urinary tract infection group. Chi-square analysis showed that the presence of urinary tract infection affected the renal function of postoperative patients. There were 4 cases with sepsis and 58 cases without sepsis after operation in the group of urinary tract infection before and after operation. The number of cases with sepsis accounted for 6.5% of that in the group of urinary tract infection. Sepsis occurred in 2 cases and no sepsis in 114 cases in the non-urinary tract infection group. The number of sepsis cases was 1.7% in the non-urinary tract infection group. Chi-square analysis showed that there was a significant relationship between urinary tract infection and postoperative uremia. Conclusion: preoperative urinary tract infection is directly related to complications such as fever, hematuria, sepsis and abnormal renal function after transurethral ureteroscopy. Therefore, before ureteroscopy, patients should perform routine urine examination and blood routine examination. If the patients are complicated with infection, they should be treated with medication and anti-infection first, and then positive bacteria culture and drug sensitivity test should be performed to identify bacteria and sensitive drugs. The patients were treated with anti-infection and urine routine was rechecked until there was no urinary tract infection in order to reduce postoperative complications.
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R699

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