CAJ | 학술논문

目的总结尿源性败血症的发病特点、早期症状及诊治经验,降低发生率及病死率.方法回顾性分析浙江大学附属第一医院2008年8月至2012年4月因泌尿系疾病治疗过程中并发的尿源性败血症30例患者的临床资料,探讨尿源性败血症的早期症状、早期诊治措施及转归.30例中,男10例,女20例,平均年龄55.7岁.其中,输尿管结石行钬激光碎石术后3例,一侧输尿管梗阻后继发3例,经尿道前列腺电切(TURP)术后2例,经尿道膀胱肿瘤电切(TURB)术后1例,膀胱全切+ Bricker膀胱术后3例,经皮肾镜碎石(PCNL)术中、术后18例.结果 12例PCNL患者术中即出现非出血因素引起的血压明显下降.26例术后2h即出现寒战、高热.血压下降和高热是尿源性败血症的最早症状.经积极抗感染和对症处理,27例抢救成功,3例死亡,1例为输尿管镜下钬激光碎石术后,1例为PCNL术后,1例为TURP术后,病死率10％.结论尿源性败血症起病隐匿,一旦发生,则发展迅速,难以逆转,早期诊治有利于提高抢救成功率.
목적 총결뇨원성패혈증적발병특점、조기증상급진치경험,강저발생솔급병사솔.방법 회고성분석절강대학부속제일의원2008년8월지2012년4월인비뇨계질병치료과정중병발적뇨원성패혈증30례환자적림상자료,탐토뇨원성패혈증적조기증상、조기진치조시급전귀.30례중,남10례,녀20례,평균년령55.7세.기중,수뇨관결석행화격광쇄석술후3례,일측수뇨관경조후계발3례,경뇨도전렬선전절(TURP)술후2례,경뇨도방광종류전절(TURB)술후1례,방광전절+ Bricker방광술후3례,경피신경쇄석(PCNL)술중、술후18례.결과 12례PCNL환자술중즉출현비출혈인소인기적혈압명현하강.26례술후2h즉출현한전、고열.혈압하강화고열시뇨원성패혈증적최조증상.경적겁항감염화대증처리,27례창구성공,3례사망,1례위수뇨관경하화격광쇄석술후,1례위PCNL술후,1례위TURP술후,병사솔10％.결론 뇨원성패혈증기병은닉,일단발생,칙발전신속,난이역전,조기진치유리우제고창구성공솔.
Objective To explore the characteristics,early symptoms and valuable experiences in the diagnosis and treatment of urine-induced sepsis.Methods The clinical data of 30 cases of urine-induced sepsis between August 2008 and April 2012 were reviewed retrospectively.Among them,YAG laser lithotripsy (n =3) and transurethral prostatic resection (TURP) (n =2) were performed.One case was after transurethral resection of bladder (TURB).There were 3 cases after cystectomy and Bricker and another 18 during and after percutaneous nephrolithotomy (PCNL).Results A total of 12 PCNL cases have significant drop in blood pressure during operation with non-bleed causes.A total of 26 cases developed symptoms of chills and high fever after 2 hours of surgery.The earliest symptoms of urine-induced sepsis were decline in blood pressure and high fever.After resistance to infection and symptomatic treatment actively,27 patients were rescued successful (90％),3 patients died (10％).Among the 3 deceased patients,1 case was after YAG laser lithotripsy under ureteroscope,1 case was after PCNL,1 case was after TURP.Conclusions The onset of urine-induced sepsis onset may be insidious.But this condition deteriorates rapidly and it is rather difficult to reverse.Most cases could be managed when the onset characteristics were recognized early.Prevention and early treatment are keys of lowering the mortality.