CAJ | 학술논문

目的:总结探讨经皮肾镜碎石取石术(Percutaneous Nephrolithotomy,PCNL)并发尿源性脓毒血症休克的防治措施.方法:回顾性分析2010年1月至2014年11月治疗的714例PCNL患者,其中9例术后并发尿源性脓毒血症患者的临床资料.9例患者术后1~4 h内出现寒战、呼吸急促(呼吸>30次/min)、高热(体温>39.0℃),心率加快(120~160次/min),血压下降(<90/60 mmHg),血常规提示白细胞>20×109/L或<4×109/L,血小板<60×109/L.临床诊断为尿源性脓毒血症休克,给予抗感染、抗休克等治疗.结果:早期由于认识及经验不足,3例患者因多器官功能衰竭死亡.在总结早期经验的基础上,加强围手术期预防并早期及时治疗,后期6例患者治愈出院.结论:PCNL术后尿源性脓毒血症休克起病急、发展迅速,加强围手术期的预防,早期诊断并及时治疗,能有效降低术后尿源性脓毒血症休克的发生率及病死率.
목적:총결탐토경피신경쇄석취석술(Percutaneous Nephrolithotomy,PCNL)병발뇨원성농독혈증휴극적방치조시.방법:회고성분석2010년1월지2014년11월치료적714례PCNL환자,기중9례술후병발뇨원성농독혈증환자적림상자료.9례환자술후1~4 h내출현한전、호흡급촉(호흡>30차/min)、고열(체온>39.0℃),심솔가쾌(120~160차/min),혈압하강(<90/60 mmHg),혈상규제시백세포>20×109/L혹<4×109/L,혈소판<60×109/L.림상진단위뇨원성농독혈증휴극,급여항감염、항휴극등치료.결과:조기유우인식급경험불족,3례환자인다기관공능쇠갈사망.재총결조기경험적기출상,가강위수술기예방병조기급시치료,후기6례환자치유출원.결론:PCNL술후뇨원성농독혈증휴극기병급、발전신속,가강위수술기적예방,조기진단병급시치료,능유효강저술후뇨원성농독혈증휴극적발생솔급병사솔.
Objective: To summerize and explore the prevention of uroseptic shock after percutaneous nephrolithotomy. Methods:Clinical data of 714 PCNL patients from January 2010 to November 2014 were retrospectively analyzed, among them, 9 were with uroseptic after percutaneous nephrolithotomy. All 9 patients were characterized by chills, a breathing over 30 BPM, a temperature over 39.0 ℃, a heart rate from 120 to 160 BPM and a blood pressure below 90/60 mmHg within 1-4 hours after operation. They were diagnosed with uroseptic shock by clinical manifestations and were treated by anti-infection and anti-shock therapies. Results: At early stage, due to the lack of knowledge and experience, 3 patients died of multiple organ dysfunction failure. 6 patients were cured with early diagnosis and rapid treatment after summarizing the cause of failure. Conclusion:Uroseptic shock can develop rapidly after percutaneous nephrolithotomy. Effective prevention, early diagnosis and treatment can prevent uroseptic shock.