CAJ | 학술논문

[目的]回顾性分析37例经皮肾镜取石术（PCNL ）术后感染性休克的临床诊治，探讨防治措施。[方法]回顾分析2007年1月至2013年6月37例PCNL术后继发感染性休克患者的临床资料。37例中男性21例，女性16例，平均年龄43．2岁，结石最大径≥2．5 cm ，左侧26例，右侧11例，术前23例尿培养阳性。确诊休克后纠正血容量，使用敏感抗生素、激素、血管活性及碱性药物治疗。[结果]37例患者无一例死亡，按手术方式分为一期单纯肾造瘘组（6例），碎石造瘘组（9例），碎石清石术组（22例）。休克发生于术后1～9h，持续8～212 h；高热期血培养阳性率83．78％（31/37），与尿培养符合率61．30％（19/37）。单纯肾造瘘组与其它组比较，休克发生晚，持续时间短，且差异有显著性（ P ＜0．05）。[结论]感染性休克是PCNL的严重并发症之一，有明确感染者术前使用有效抗生素，一期单纯肾脏造瘘、及时抗休克治疗可以有效阻止病情进展和降低病死率。
[목적]회고성분석37례경피신경취석술（PCNL ）술후감염성휴극적림상진치，탐토방치조시。[방법]회고분석2007년1월지2013년6월37례PCNL술후계발감염성휴극환자적림상자료。37례중남성21례，녀성16례，평균년령43．2세，결석최대경≥2．5 cm ，좌측26례，우측11례，술전23례뇨배양양성。학진휴극후규정혈용량，사용민감항생소、격소、혈관활성급감성약물치료。[결과]37례환자무일례사망，안수술방식분위일기단순신조루조（6례），쇄석조루조（9례），쇄석청석술조（22례）。휴극발생우술후1～9h，지속8～212 h；고열기혈배양양성솔83．78％（31/37），여뇨배양부합솔61．30％（19/37）。단순신조루조여기타조비교，휴극발생만，지속시간단，차차이유현저성（ P ＜0．05）。[결론]감염성휴극시PCNL적엄중병발증지일，유명학감염자술전사용유효항생소，일기단순신장조루、급시항휴극치료가이유효조지병정진전화강저병사솔。
[Objective] To retrospectively analyze clinical diagnosis and treatment of septic shock after per-cutaneous nephrolithotomy ,and to explore the prevention and treatment method .[Methods] Clinical data of 37 patients with secondary septic shock after percutaneous nephrolithotomy from Jan .2007 to June 2013 were analyzed retrospectively .Among 37 patients ,there were 21 males and 16 females .The mean age was 43 .2 years old .The maximum diameter of stones was ≥2 .5cm .There were 26 cases of left kidney stones and 11 cases of right kidney stones .Bacterial culture in preoperative urine was positive in 23 patients .After septic shock was confirmed ,blood volume was redressed ,and sensitive antibiotics ,hormones ,vasoactive drugs and alkaline were used for the treatment .[Results] No death was observed in 37 patients .According to surgical approach ,all patients were divided into one-stage simple nephrostomy group( n=6) ,gravel ostomy group( n=9) and stone clearance surgery group ( n = 22) .Shock occurred 1~9h after operation for continuous 8~212h .Blood culture positive rate in fever stage was 83 .78% (31/37) ,and the coincidence rate of blood culture and urine culture was 61 .30% (19/37) .Compared with the other groups ,the occurrence of shock was late and the duration was short in simple nephrostomy group ,and there was significant difference( P<0 .05) .[Conclu-sion]Septic shock is one of serious complications of percutaneous nephrolithotomy .Patients with preoperative infection should be given effective antibiotic therapy .One-stage simple colostomy and prompt anti-shock treat-ment can effectively prevent disease progression and reduce the mortality .