上尿路结石腔道手术后并发尿脓毒血症的危险因素分析

Risk factors analysis for urosepsis following endourological treatment of upper urinary stones

摘要:

目的：探讨上尿路结石腔道手术并发尿脓毒血症的危险因素，手术方式包括经皮肾镜碎石取石术（percutaneous nephrolithotomy，PCNL）、输尿管硬镜碎石取石术（rigid ureteroscopic lithotripsy）、输尿管软镜碎石取石术（flexible ureteroscopic lithotripsy）。方法：收集我院2013年1月至2017年1月上尿路结石且接受腔道手术治疗的患者，排除孤立肾、马蹄肾以及术前已出现尿脓毒血症或诊断为肾积脓、脓肾的患者。分别收集经皮肾镜碎石取石术2 032例，输尿管硬镜碎石取石术1 781例，输尿管软镜碎石取石术625例，其中分别发生尿脓毒血症123例、98例、37例；发生率分别为6.05%、5.50%、5.92%。未发生脓毒血症的患者为对照组，发生脓毒血症的患者为病例组。首先将术后脓毒血症发生的相关因素进行单因素分析（卡方检验），再将有统计学意义的危险因素用多元logistic回归方法进行多因素分析。找出与术后发生尿脓毒血症密切相关的因素。结果：多因素logistic回归结果显示，尿常规（OR95%CI=2.008~7.584）、尿培养（OR95%CI=1.496~3.489）、结石大小（OR95%CI=1.811~5.420）与PCNL术后尿脓毒血症的发生密切相关。尿常规（OR95%CI=1.602~6.776）、尿培养（OR95%CI=2.659~7.924）与输尿管硬镜术后尿脓毒血症的发生密切相关。尿培养（OR95%CI=1.739~12.770）输尿管软镜术后尿脓毒血症的发生密切相关。结论：术前已存在尿路感染是上尿路结石腔道手术发生尿脓毒血症的最重要危险因素，在PCNL中，结石大小也是尿脓毒血症发生的重要危险因素。

Abstract:

Objective：In order to explore the potential risk factors for urosepsis following endourological treatment of upper urinary stones. Surgical methods include percutaneous nephrolithotomy（PCNL），rigid ureteroscopic lithotripsy，flexible ureteroscopic lithotripsy. Methods：Totally 2 032 patients treated with PCNL，1 781 patients treated with rigid ureteroscopic lithotripsy and 625 patients treated with flexible ureteroscopic lithotripsy were collected from January 2013 to January 2017. Association between different groups was as－sessed by Chi squar to find out the related factors. Then multivariate logistic regression analysis on these related factors was used to further analysis. Results：Multivariate logistic regression analysis showed that urine routine examination（OR95%CI=2.008 to 7.584），urine culture examination（OR95%CI=1.496 to 3.489），stone size（OR95%CI=1.811 to 5.420） were related with urinary sepsis follow－ing PCNL. Urine routine examination（OR95%CI=1.602 to 6.776），urine culture examination（OR95%CI=2.659 to 7.924） were related with urinary sepsis following rigid ureteroscopic lithotripsy. Urine culture examination（OR95%CI=1.739 to 12.770） was related with urosepsis following flexible ureteroscopic lithotripsy. Conlusion：Preoperative urinary tract infection is the most important factor for urosepsis following endourological management of upper urinary stones. In addition，stone size is also one of the important factors for urosepsis after PCNL.