PCNL术后并发尿脓毒血症相关因素及防治分析.docVIP

PCNL术后并发尿脓毒血症相关因素及防治分析 　　doi：10.3969/j.issn.1007-614x.2014.17.43 　　摘要目的：探讨经皮肾镜取石（PCNL）术后尿脓毒血症的原因及防治策略。方法：回顾性分析1 260例PCNL患者的临床资料。结果：1 260例患者术后发生尿脓毒血症24例。其中结石直径2cm、鹿角形结石、术前有尿路感染、手术时间60分钟、术中灌注泵压力120mmHg的发生率均高于对照组，组间比较差异均有统计学意义（P0.05）。24例患者均经抗感染、扩容等治疗后治愈。结论：结石体积大、鹿角形肾结石、术前合并尿路感染、手术时间长、灌注泵压力高是PCNL术后尿脓毒血症的危险因子。抗生素及扩容是其治疗的关键。 　　关键词经皮肾镜取石术肾结石尿脓毒血症治疗 　　Analysis of relevant factors and prevention and treatment of PCNL postoperation combined with urinary sepsis 　　Ge Weijun，Yang Huawei，Xie Xiao 　　Urology Surgery，the First Affiliated Hospital of Hunan University of Chinese Medicine（Changsha City，Hunan），410007 　　AbstractObjective：To explore the cause and strategy of prevention and treatment of urinary sepsis after percutaneous nephrolithotomy operation.Methods：The clinical data of 1260 cases of PCNL patients were retrospectively analyzed.Results：In 1260 cases，24 cases occured urinary sepsis after operation.The incidence rates of the stone diameter more than 2cm，staghorn calculi，preoperative urinary tract infection，operation time more than 60 minutes，intraoperative perfusion pump pressure more than 120mmHg were higher than those of the control group.The differences between groups were statistically significant（P0.05）.24 cases were cured by treating with anti infection and dilatancy.Conclusion：The big stone volume，antler shape kidney stones， preoperative urinary tract infection，long operation time，the high perfusion pump pressure are the risk factors for urinary sepsis after PCNL operation.Antibiotics and expansion are the key to treatment. 　　Key wordsPercutaneous nephrolithotomy；Renal calculus；Urinary sepsis；Therapy 　　经皮肾镜取石术因其微创、恢复快等优点，目前已成为上尿路结石的主要治疗方式。但仍有出血、结石残留、术后感染等并发症的可能。其中术后早期发生的尿脓毒血症是其最严重的并发症之一。我院2005年10月-2013年10月因上尿路结石行PCNL患者1260例，术后发生尿脓毒血症24例。通过总结这些患者的临床资料，分析导致术后发生尿脓毒血症的相关因素及治疗方法，探讨其防治策略，现报告如下。 　　资料与方法 　　2005年10月-2013年10月收治上尿路结石住院患者1 260例，男751例，女509例。年龄15～80岁。平均年龄45岁。其中肾结石1 020例，输尿管上段结石175例，输尿管结石合并肾结石105例，结石最大径0.8～5.0cm，平均2.5cm。合并中度以上肾积水1 032例，轻度或无肾积水228例。术前均