本文關(guān)鍵詞： 經(jīng)皮腎鏡碎石取石術(shù) 全身炎癥反應(yīng)綜合征 中性粒細(xì)胞 淋巴細(xì)胞 單核細(xì)胞　出處：《中國微創(chuàng)外科雜志》2017年11期 　論文類型：期刊論文

【摘要】：目的探討外周血炎性指標(biāo)與經(jīng)皮腎鏡碎石取石(percutaneous nephrolithotomy,PCNL)術(shù)后發(fā)生全身炎癥反應(yīng)綜合征(systemic inflammation response syndrome,SIRS)的關(guān)系。方法回顧性分析2015年1月~2016年6月我科175例PCNL的臨床資料,其中術(shù)后發(fā)生SIRS 52例(SIRS+組),未發(fā)生SIRS 123例(SIRS-組)。采用logistic回歸分析PCNL術(shù)后發(fā)生SIRS的預(yù)后因素。外周血炎性指標(biāo)包括中性粒細(xì)胞/淋巴細(xì)胞比值(neutrophil to lymphocyte ratio,NLR)、中性粒細(xì)胞/單核細(xì)胞比值(neutrophil to monocyte ratio,NMR)、術(shù)后NLR/術(shù)前NLR(NLR比值)和術(shù)后NMR/術(shù)前NMR(NMR比值)。其他研究指標(biāo)包括年齡、性別、ASA分級、是否有同側(cè)結(jié)石手術(shù)史、是否術(shù)前留置雙J管或腎造瘺管、術(shù)前血肌酐、術(shù)前尿培養(yǎng)是否陽性、手術(shù)時(shí)間、是否多通道、是否同期行輸尿管鏡操作、術(shù)中是否出現(xiàn)心動過速和術(shù)后是否輸血等。結(jié)果單因素分析顯示術(shù)后即刻外周血炎性指標(biāo)升高、女性、術(shù)前尿培養(yǎng)陽性、多通道手術(shù)、手術(shù)時(shí)間長和術(shù)后輸血與術(shù)后SIRS的發(fā)生相關(guān)(P0.05)。多因素logistic回歸分析顯示NMR比值是PCNL術(shù)后發(fā)生SIRS的獨(dú)立預(yù)后因素,將NMR比值根據(jù)四分位數(shù)分為4組,Q50~Q75組和Q75組發(fā)生SIRS的風(fēng)險(xiǎn)是Q25組的6.5倍和8.5倍(OR=6.534,95%CI:1.031~41.429,P=0.046;OR=8.591,95%CI:1.095~67.422,P=0.041)。結(jié)論術(shù)后即刻外周血炎性指標(biāo)、性別、術(shù)前尿培養(yǎng)是否陽性、是否多通道手術(shù)、手術(shù)時(shí)間、術(shù)后是否輸血與PCNL術(shù)后SIRS的發(fā)生相關(guān),其中NMR比值是PCNL術(shù)后發(fā)生SIRS的獨(dú)立預(yù)后因素。
[Abstract]:Objective to investigate the relationship between peripheral blood inflammatory index and percutaneous nephrolithotomy with percutaneous nephrolithotripsy. The systemic inflammatory response syndrome (inflammation response syndrome) occurred after PCNL. Methods the clinical data of 175 cases of PCNL from January 2015 to June 2016 in our department were analyzed retrospectively. 52 cases of SIRS occurred after operation in Sirs group. No SIRS in 123 cases of SIRS- group). Logistic regression analysis was used to analyze the prognostic factors of SIRS after PCNL. The peripheral blood inflammatory markers included neutrophil / lymphocyte ratio (P < 0.05). Neutrophil to lymphocyte ratio. The ratio of neutrophil to monocyte / monocyte was NMRs. The ratio of postoperative NLR / preoperative NLR(NLR) and postoperative NMRs / preoperative NMR(NMR ratio were measured. Other parameters included age, sex, and history of operation for ipsilateral calculi. Whether to place double J tube or nephrostomy tube before operation, serum creatinine before operation, positive urine culture before operation, operation time, multichannel, and ureteroscope operation at the same time. Results univariate analysis showed that the peripheral blood inflammatory index increased immediately after operation, female, urine culture positive before operation, multi-channel operation. Long operation time and postoperative blood transfusion were associated with postoperative SIRS (P0.05). Multivariate logistic regression analysis showed that NMR ratio was an independent prognostic factor for SIRS after PCNL. NMR ratio was divided into 4 groups according to quartile. The risk of developing SIRS in Q50 Q75 group and Q75 group was 6.5 times and 8.5 times higher than that in Q25 group. 95 CI: 1.031, 41.429, Pu 0.046; Conclusion Peripheral blood inflammatory markers, sex and urine culture were positive or not immediately after operation. Whether multichannel operation, time of operation, blood transfusion after operation is related to the occurrence of SIRS after PCNL, the ratio of NMR is an independent prognostic factor of SIRS after PCNL.
【作者單位】： 北京大學(xué)人民醫(yī)院泌尿外科;北京大學(xué)應(yīng)用碎石技術(shù)研究所;
【分類號】：R699.2
【正文快照】： *通訊作者,E-mail:huang6299@sina.comoperation time,number of access,and blood transfusion are correlated with occurrence of SIRS after PCNL.Post NMR/pre NMR is anindependent prognostic factor for the occurrence of SIRS after PCNL.經(jīng)皮腎鏡碎石取石術(shù)(percut

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