武利兵;
WU Libing;Department of Urology,Liangxiang Hospital in Fangshan District;

• 1:房山区良乡医院泌尿外科

摘要(Abstract)：

目的:探讨经皮肾镜碎石术(PCNL)治疗肾铸型结石性脓肾术后并发全身性炎症反应综合征(SIRS)的危险因素。方法:接受Ⅰ期PCNL治疗的肾铸型结石性脓肾患者168例,分为SIRS组(n=22)和非SIRS组(n=146),比较2组患者性别、年龄等一般资料、术后24 h患者肾功能和血脂指标、血清内毒素(ET)、降钙素原(PCT)及C反应蛋白(CRP)水平;对两组比较有差异指标进行Logistic回归分析,探讨并发SIRS的危险因素。结果:两组患者年龄、结石数量、手术时间、术前应用抗生素、肾功能不全、术前尿路感染、手术为单通道、是否需要输血、灌洗液流量>500 m L/min等因素比较,差异有统计学意义(P<0.05);SIRS组术后24 h血清CRP、ET、PCT水平显著高于非SIRS组(P<0.05);Logistic回归分析显示,结石数量为多发、灌洗液流量>500 m L/min、肾功能不全、术前尿路感染、手术为单通道、术后血清ET和PCT水平升高是并发SIRS的危险因素,术前应用抗生素为保护因素。结论:术前应用抗生素,术后监测血清ET、PCT水平可预防术后SIRS的发生。
Objective:To explore the risk factors of postoperative systemic inflammatory response syndrome(SIRS) after percutaneous nephrolithotomy(PCNL) for renal calculi complicated with pyonephrosis.Methods:168 cases of renal calculi complicated with pyonephrosis patients treated with PCNL I were divided into SIRS group(n = 22) and non SIRS group(n = 146).Gender,age and other general data,renal function and blood lipids 24 h after operation,serum endotoxin(ET),procalcitonin(PCT) and C reactive protein(CRP) levels were compared between the two groups,and Logistic regression analysis were used to analyze the risk factors of SIRS.Results:Age,stone number,operation time,preoperative use of antibiotics,renal insufficiency,preoperative urinary tract infection,surgery for single channel,whether need blood transfusion and lavage fluid flow > 500 m L/min were different between the two groups(P < 0.05).The postoperative levels of serum CRP,ET and PCT in SIRS group were significantly higher than those in non SIRS group(P < 0.05).The results of Logistic regression analysis showed that t Logistic regression analysis showed that the number of stones was multiple,lavage fluid flow > 500 m L/min,renal insufficiency,preoperative urinary tract infection,surgery for single channel,increase of postoperative serum ET and PCT levels were risk factors associated with SIRS,preoperative use of antibiotics were protective factors.Conclusions:Preoperative application of antibiotics,postoperative monitoring of serum ET,PCT levels can prevent the occurrence of postoperative SIRS.

关键词(KeyWords)： 经皮肾镜碎石术;肾铸型结石,Ⅰ期;脓肾;全身性炎症反应综合征;危险因素
percutaneous nephrolithotomy;renal cast calculi;pyonephrosis;systemic inflammatory response syndrome;risk factors

Abstract:

Keywords:

基金项目(Foundation): 首都卫生发展科研专项项目(首发2011-7062-01)

作者(Author): 武利兵;
WU Libing;Department of Urology,Liangxiang Hospital in Fangshan District;

Email:

DOI: 10.19367/j.cnki.1000-2707.2017.02.023

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