摘要
目的探讨上尿路结石合并肾积水患者经皮肾镜取石术(percutaneous nephrolithotomy,PCNL)术后并发全身炎症反应综合征(systemic inflammatory response syndrome,SIRS)的影响因素。方法回顾性分析2016年8月至2018年8月承德医学院附属医院收治的上尿路结石合并肾积水并接受PCNL治疗患者的临床资料,收集患者术前和术中各项因素,评估患者术后并发SIRS的影响因素。结果本研究120例患者中,38例术后发生SIRS,发生率为31.67%。所有发生SIRS的患者均未进一步发展为多器官功能不全,无肾盂、肾盏撕裂穿孔等严重并发症,无死亡病例。单因素分析结果显示,术前尿培养结果、是否合并糖尿病、有无肾功能不全、结石数目、有无术后残石、有无鹿角形肾结石、术中灌注压力、有无体外冲击波碎石术(extracorporeal shock wave lithotripsy,ESWL)手术史、手术时间均为上尿路结石合并肾积水患者PCNL术后发生SIRS的影响因素(均P<0.05)。多因素Logistic回归分析结果显示,合并糖尿病、术前尿培养阳性、肾功能不全、鹿角形肾结石、术中灌注压力≥20 kPa、有ESWL手术史、手术时间>90 min均为上尿路结石合并肾积水患者PCNL术后发生SIRS的危险因素(均P<0.05)。结论上尿路结石合并肾积水患者PCNL术后发生SIRS的影响因素较多,在治疗过程中,应针对存在危险因素的患者给予针对性的干预措施,以降低SIRS的发生率,对提高PCNL治疗的安全性具有重要价值。
Objective To investigate the influencing factors of systemic inflammatory response syndrome(SIRS)after percutaneous nephrolithotomy(PCNL)in patients with upper urinary tract calculus complicated with hydronephrosis.Method Retrospectively analyzed the clinical data of patients with upper urinary tract calculus complicated with hydronephrosis and received PCNL treatment in the Affiliated Hospital of Chengde Medical University from August 2016 to August 2018,collect preoperative and intraoperative factors in patients,and evaluate the influencing factors of postoperative complications of SIRS.Result Of the 120 patients in this study,38 cases had SIRS after operation,and the incidence was 31.67%.All patients with SIRS did not further develop multiple organ dysfunction,and there were no serious complications such as renal pelvis and renal calice tears and perforations.There were no deaths in this group of patients.The results of univariate analysis showed that the preoperative urine culture results,whether complicated with diabetes mellitus,whether had renal insufficiency,the number of stones,the presence of postoperative residual stones,the presence of staghorn calculus,intraoperative perfusion pressure,the presence of extracorporeal shock wave lithotripsy(ESWL)operation history and operation time were all the factors influencing the occurrence of SIRS in patients with upper urinary tract calculus complicated with hydronephrosis after PCNL(all P<0.05).Multivariate Logistic regression analysis showed that complicated with diabetes mellitus,positive preoperative urine culture,renal insufficiency,staghorn calculus,intraoperative perfusion pressure≥20 kPa,history of ESWL operation and operation time>90 min were all risk factors for SIRS in patients with upper urinary tract calculus complicated hydronephrosis after PCNL(all P<0.05).Conclusion There are many factors influencing the occurrence of SIRS after PCNL in patients with upper tract calculus complicated with hydronephrosis.In the course of treatment,targeted interventions should be given for patients with risk factors to reduce the occurrence of SIRS.The incidence is of great value in improving the safety of PCNL treatment.
作者
冯兵
于昕冉
Feng Bing;Yu Xinran(Department of Critical Care Medicine,Affiliated Hospital of Chengde Medical University,Hebei,Chengde 067000,China)
出处
《中国医学前沿杂志（电子版）》
2021年第10期71-75,共5页
Chinese Journal of the Frontiers of Medical Science(Electronic Version)
基金
2020年承德市科学技术研究与发展计划项目(202006A051)。
关键词
上尿路结石
肾积水
经皮肾镜取石术
全身炎症反应综合征
Upper urinary tract calculus
Hydronephrosis
Percutaneous nephrolithotomy
Systemic inflammatory response syndrome
