一期经皮肾镜手术治疗无发热结石性脓肾术后发生全身炎症反应综合征的危险因素分析

摘要/Abstract

摘要： 目的：探讨一期经皮肾镜碎石术（percutaneous nephrolithotomy, PCNL）治疗无发热结石性脓肾术后发生全身炎症反应综合征（systemic inflammatory response syndrome，SIRS）的危险因素。方法：回顾性分析2008年1月至2013年12月连续收治的所有结石性脓肾患者的一期PCNL手术资料。分析术前尿白细胞数、术前尿培养阳性、肾功能不全、术前应用抗生素3天以上、手术时间、手术通道数、术中灌洗液流速大于500 mL/min、输血、鸟粪石等9个因素对患者术后发生SIRS的影响。结果：共入选182例患者，术后SIRS共发生38例（20.88%）。SIRS组与非SIRS组在术前尿白细胞数（P=0.483）、术前尿培养阳性（P=0.136）、鸟粪石（P=0.324）3个方面差异无统计学意义。多因素Logistic回归结果显示，无发热结石性脓肾PCNL术后发生SIRS的独立危险因素有5个，分别为：肾功能不全（OR=5.41, 95% CI 1.84~22.64, P=0.014）、手术时间（OR=1.01, 95% CI 1.00~1.02, P=0.024）、手术通道数目（OR=3.37, 95% CI -1.92~32.55, P=0.077）、术中灌洗液流量大于500 mL/min（OR=45.87，95% CI 4.39~231.68, P=0.007）、输血（OR=5.98, 95% CI 1.12~46.66, P=0.043）。无发热结石性脓肾PCNL术后发生SIRS的独立保护因素有1个，即术前应用抗生素3天以上（OR=0.34, 95% CI -3.92~12.55, P=0.047）。结论：PCNL治疗无发热结石性脓肾术后发生SIRS的概率与其他患者相近，手术相对安全可行。术前应使用抗生素3天以上再行手术治疗。术中需仔细操作避免输血，尽量缩短手术时间，减少多通道手术，尤其应避免因尿液浑浊、出血等视野不清楚导致的灌洗液流量大于500 mL/min的情况。

关键词: 肾结石, 肾造口术, 经皮, 全身炎症反应综合征, 肾积脓, 危险因素

Abstract: Objective：To investigate the risk factors of systemic inflammatory response syndrome (SIRS) after one-phase treatment for apyrexic calculous pyonephrosis by percutaneous nephrolithotomy (PCNL). Methods: Clinical data of consecutive apyrexic calculous pyonephrosis patients who underwent one-stage PCNL from January 2008 to December 2013 were analyzed retrospectively. The data collected included white blood cells in urine analysis before surgery, midstream urine culture, preoperative renal function, using antibiotics time before surgery, operative time, the number of tracts, intraoperative irrigation peak flow, blood transfusion, and stone composition. Chi-square, t test and Logistic regression methods were used for analysis of each factor and SIRS. Results: A total of 182 patients were enrolled in this study and 38 patients developed SIRS (20.88%). There were no statistically significant differences among white blood cells in urine analysis (P=0.483), urine culture positive (P=0.136), and struvite (P=0.324) in terms of the incidence of postoperative SIRS. Multivariate Logistic regression model indicated that risk factors of SIRS for apyrexic calculous pyonephrosis after one-phase PCNL were renal insufficiency (OR=5.41, 95% CI 1.84 to 22.64, P=0.014), operative time (OR=1.01, 95% CI 1.00 to 1.02, P=0.024), operative tracts (OR=3.37, 95% CI-1.92 to 32.55, P=0.077), intraoperative irrigation peak flow ≥500 mL/min (OR=45.87，95% CI 4.39 to 231.68, P=0.007), and blood transfusion (OR=5.98, 95% CI 1.12 to 46.66, P=0.043). The protective factor was antibiotics use for more than 3 days (OR=0.34, 95% CI -3.92 to 12.55, P=0.047). Conclusion: The incidence of SIRS after one-phase PCNL treatment for apyrexic calculous pyonephrosis was similar to that of other patients. It is relatively safe and reliable to do this. Preoperative antibiotics should be used for more than 3 days before surgery. Careful manipulation is needed to avoid blood transfusion. It is better to shorten the operative time and to reduce multiple tracts operation. Particularly, irrigation peak flow ≥500 mL/min should be avoided in the circumstance of bleeding or turbid urine.

Key words: Kidney calculi, Nephrostomy, percutaneous, Systemic inflammatory response syndrome, Pyonephrosis, Risk factors

陈亮, 李建兴, 黄晓波, 王晓峰. 一期经皮肾镜手术治疗无发热结石性脓肾术后发生全身炎症反应综合征的危险因素分析[J]. 北京大学学报（医学版）, 2014, 46(4): 566-569.

CHEN Liang, LI Jian-Xing, HUANG Xiao-Bo, WANG Xiao-Feng. Analysis for risk factors of systemic inflammatory response syndrome after onephase treatment for apyrexic calculous pyonephrosis by percutaneous nephrolithotomy[J]. Journal of Peking University(Health Sciences), 2014, 46(4): 566-569.

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