中华泌尿外科杂志
中華泌尿外科雜誌
중화비뇨외과잡지
CHINESE JOURNAL OF UROLOGY
2015年
1期
50-53
,共4页
经皮肾镜取石术%尿源性脓毒血症%危险因素
經皮腎鏡取石術%尿源性膿毒血癥%危險因素
경피신경취석술%뇨원성농독혈증%위험인소
Percutaneous nephrolithotomy%Urosepsis%Risk factors
目的 探讨经皮肾镜取石术(PCNL)术后发生尿源性脓毒血症的危险因素. 方法 回顾性分析2013年1月至2014年1月204例行PCNL的肾结石或输尿管上段结石患者的临床资料.男140例,女64例.年龄29～75岁,平均49岁.术前尿培养阳性率为14.7％ (30/204);血肌酐46～340 μmol/L,平均(87.9±33.9) μmol/L.结石直径1.0～7.0 cm,平均(2.3±0.8)cm,其中鹿角形结石51例.204例均行PCNL,其中采用标准通道84例,微通道120例.采用单因素分析和Logistic回归分析法分析PCNL术后发生尿源性脓毒血症的危险因素. 结果 本组204例手术时间23～219 min,平均(68.4±26.9) min.术后9例(4.4％)发生尿源性脓毒血症,男2例,女7例.年龄20～73岁,平均(52.6± 15.2)岁.术前尿培养阳性7例.血肌酐67～ 134 μmmol/L,(85.4±24.8) μmmol/L.结石直径1.8 ～ 3.5 cm,平均(2.5±0.6)cm,其中鹿角形结石5例.采用标准通道5例,微通道4例.手术时间47～219 min,平均(86±53) min.单因素分析结果显示女性、术前尿培养阳性、鹿角形结石及手术时间＞90 min与尿源性脓毒血症的发生有关(P均＜0.05).多因素分析结果显示女性(OR=6.001,95％CI:1.190～ 30.276)、术前尿培养阳性(OR=19.647,95％CI:3.918～98.562)与尿源性脓毒血症的发生相关(P均＜0.05). 结论 女性、术前尿培养阳性是PCNL术后发生尿源性脓毒血症的危险因素.
目的 探討經皮腎鏡取石術(PCNL)術後髮生尿源性膿毒血癥的危險因素. 方法 迴顧性分析2013年1月至2014年1月204例行PCNL的腎結石或輸尿管上段結石患者的臨床資料.男140例,女64例.年齡29～75歲,平均49歲.術前尿培養暘性率為14.7％ (30/204);血肌酐46～340 μmol/L,平均(87.9±33.9) μmol/L.結石直徑1.0～7.0 cm,平均(2.3±0.8)cm,其中鹿角形結石51例.204例均行PCNL,其中採用標準通道84例,微通道120例.採用單因素分析和Logistic迴歸分析法分析PCNL術後髮生尿源性膿毒血癥的危險因素. 結果 本組204例手術時間23～219 min,平均(68.4±26.9) min.術後9例(4.4％)髮生尿源性膿毒血癥,男2例,女7例.年齡20～73歲,平均(52.6± 15.2)歲.術前尿培養暘性7例.血肌酐67～ 134 μmmol/L,(85.4±24.8) μmmol/L.結石直徑1.8 ～ 3.5 cm,平均(2.5±0.6)cm,其中鹿角形結石5例.採用標準通道5例,微通道4例.手術時間47～219 min,平均(86±53) min.單因素分析結果顯示女性、術前尿培養暘性、鹿角形結石及手術時間＞90 min與尿源性膿毒血癥的髮生有關(P均＜0.05).多因素分析結果顯示女性(OR=6.001,95％CI:1.190～ 30.276)、術前尿培養暘性(OR=19.647,95％CI:3.918～98.562)與尿源性膿毒血癥的髮生相關(P均＜0.05). 結論 女性、術前尿培養暘性是PCNL術後髮生尿源性膿毒血癥的危險因素.
목적 탐토경피신경취석술(PCNL)술후발생뇨원성농독혈증적위험인소. 방법 회고성분석2013년1월지2014년1월204례행PCNL적신결석혹수뇨관상단결석환자적림상자료.남140례,녀64례.년령29～75세,평균49세.술전뇨배양양성솔위14.7％ (30/204);혈기항46～340 μmol/L,평균(87.9±33.9) μmol/L.결석직경1.0～7.0 cm,평균(2.3±0.8)cm,기중록각형결석51례.204례균행PCNL,기중채용표준통도84례,미통도120례.채용단인소분석화Logistic회귀분석법분석PCNL술후발생뇨원성농독혈증적위험인소. 결과 본조204례수술시간23～219 min,평균(68.4±26.9) min.술후9례(4.4％)발생뇨원성농독혈증,남2례,녀7례.년령20～73세,평균(52.6± 15.2)세.술전뇨배양양성7례.혈기항67～ 134 μmmol/L,(85.4±24.8) μmmol/L.결석직경1.8 ～ 3.5 cm,평균(2.5±0.6)cm,기중록각형결석5례.채용표준통도5례,미통도4례.수술시간47～219 min,평균(86±53) min.단인소분석결과현시녀성、술전뇨배양양성、록각형결석급수술시간＞90 min여뇨원성농독혈증적발생유관(P균＜0.05).다인소분석결과현시녀성(OR=6.001,95％CI:1.190～ 30.276)、술전뇨배양양성(OR=19.647,95％CI:3.918～98.562)여뇨원성농독혈증적발생상관(P균＜0.05). 결론 녀성、술전뇨배양양성시PCNL술후발생뇨원성농독혈증적위험인소.
Objective To investige the risk factors of urosepsis after percutaneous nephrolithotomy (PCNL).Methods We retrospectively analyzed 204 renal calculi or proximally ureter calcui patients,who underwent ultrasound-guided PCNL,from January 2013 to January 2014.Among them,there were 140 men and 64 women,whose mean age was 49 years (range from 29 to 75 years).Eighty-four operations were performed via standard channel and 120 operations were performed via micro channels.Fifty one patients had staghorn stones.Before operation,the urine culture positive rate was 14.7％ (30/204).The creatinine level ranged from 46 to 340 μmol/L [mean (87.9±33.9) μmol/L].Average stone diameter was (2.3±0.8) cm (range 1.0-7.0 cm).Mean operative time was (68.4±26.9) min (range 23-219 min).The chi-square test and a logistic regression model were used to identify key risk factors.Results The operation duration ranged from 23 to 219 min,mean (68.4±26.9) min.Of 204 patients,9 (4.4％) suffered septic shock,including 7 female patients and 2 male patients.Their mean age was (52.6± 15.2) years (20-73 years).Five operations were performed via standard channels and four operations were performed via micro channels.Five patients had staghorn stones.Urine culture positive rate was 77.8％ (7/9).The average stone diameter was (2.5±0.6) cm (range 1.8-3.5 cm).Mean operative time was (86±53) min (range 47-219 min).In univariate analysis,significant associations was observed between female gender (P =0.005),positive urine culture (P＜0.01),staghorn calculi (P =0.035),operative duration＞90 min (P =0.042) and sepsis after PCNL.While in multivariate analysis,female gender (OR=6.001,95％CI=1.190-30.276,P=0.03) and positive urine culture pre-operation (OR=19.647,95％CI=3.918-98.562,P＜0.01) were identified as independent risk factors for post-MPCNL septic shock.Conclusions Female gender and positive urine culture before operation are the key risk factors of urosepsis after percutaneous nephrolithotomy.
