腔镜治疗上尿路结石术后全身炎症反应综合征的危险因素分析

发布时间：2019-07-25 07:53

【摘要】：目的探讨经皮肾镜和输尿管镜上尿路结石钬激光碎石患者术后并发全身炎症反应综合征(SIRS)的危险因素。方法回顾性分析行经皮肾镜、输尿管镜钬激光碎石术的220例患者的临床资料,包括患者性别、年龄、基础疾病(高血压及糖尿病)、结石大小、部位、手术时间、术中冲洗液压力、尿白细胞及细菌培养、血白细胞和C反应蛋白(CRP)等指标,通过Logistic回归分析评估全身炎症反应综合征的危险因素。结果 38例患者出现SIRS表现。其中,3例患者出现感染性休克,经积极抗感染、对症支持治疗后均恢复,无死亡病例。经单因素分析,年龄、结石大小、手术时间、术中冲洗液压力、尿白细胞、血白细胞和CRP等指标进入Logistic回归模型。多因素分析发现手术时间、术中冲洗液压力、尿白细胞和CRP等指标可被认为腔镜钬激光碎石术后并发SIRS的独立危险因素。结论多种因素共同作用使患者行腔镜钬激光碎石术后可能出现SIRS,缩短手术时间、低压灌注、控制术前感染及急性反应可降低术后发生SIRS的可能性。
[Abstract]:Objective to investigate the risk factors of systemic inflammatory response syndrome (SIRS) in patients with upper urinary calculi treated with holmium laser lithotripsy. Methods the clinical data of 220 patients undergoing percutaneous nephroscopy and Ureteroscopic holmium laser lithotripsy, including sex, age, basic diseases (hypertension and diabetes), stone size, location, operation time, intraoperative flushing fluid pressure, urinary leukocyte and bacterial culture, blood leukocytes and C-reactive protein (CRP), were analyzed retrospectively. the risk factors of systemic inflammatory response syndrome were evaluated by Logistic regression analysis. Results SIRS findings were found in 38 patients. Among them, 3 patients developed septic shock, which recovered after active anti-infection and symptomatic support treatment, and no death occurred. Univariate analysis, age, stone size, operation time, intraoperative flushing fluid pressure, urine white blood cells, blood leukocytes and CRP entered the Logistic regression model. Multivariate analysis showed that surgical time, intraoperative flushing fluid pressure, urinary leukocytes and CRP could be considered as independent risk factors for SIRS after endoscopic holmium laser lithotripsy. Conclusion the combined action of many factors can shorten the operation time, reduce the possibility of SIRS after endoscopic holmium laser lithotripsy, control preoperative infection and acute reaction, and shorten the operation time, low pressure perfusion and control of preoperative infection and acute reaction.
【作者单位】：安徽医科大学附属安徽省立医院泌尿外科;
【分类号】：R699

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