本文選題：輸尿管鏡碎石術(shù) + 尿源性膿毒血癥�。� 參考：《蘇州大學(xué)》2014年碩士論文

【摘要】：目的 輸尿管鏡碎石術(shù)繼發(fā)尿源性膿毒血癥是嚴(yán)重并發(fā)癥。通過分析輸尿管鏡碎石術(shù)相關(guān)尿源性膿毒血癥發(fā)生的危險因素，探討其發(fā)病特點和診治要點。 方法 收集昆山市中醫(yī)院2009年7月~2013年7月期間642例輸尿管鏡碎石術(shù)患者的臨床資料，對37例繼發(fā)尿源性膿毒血癥患者的臨床指標(biāo)進(jìn)行單因素及多因素Logistic回歸分析，找到輸尿管鏡碎石術(shù)繼發(fā)尿源性膿毒癥的相關(guān)危險因素。 結(jié)果 1.642例輸尿管鏡碎石術(shù)患者中，繼發(fā)尿源性膿毒血癥患者37例，發(fā)病率為5.7%。經(jīng)過積極治療，治愈34例，好轉(zhuǎn)1例，死亡2例（0.3%）。 2.單因素分析顯示：高齡（70歲）、女性、糖尿病、術(shù)前中段尿細(xì)菌培養(yǎng)陽性、手術(shù)時間1小時與并發(fā)尿源性膿毒血癥相關(guān)，具有統(tǒng)計學(xué)差異（P 0.05）。 3.多因素分析顯示：女性、糖尿病、術(shù)前中段尿培養(yǎng)陽性、手術(shù)時間1小時是并發(fā)尿源性膿毒血癥的獨立危險因素，具有統(tǒng)計學(xué)差異（P0.05）。 4.結(jié)石大小、息肉包裹與繼發(fā)尿源性膿毒血癥無關(guān)，不具有統(tǒng)計學(xué)差異（P0.05）。 結(jié)論 1女性、糖尿病，術(shù)前中段尿培養(yǎng)陽性、手術(shù)時間長（1小時）是輸尿管鏡碎石術(shù)繼發(fā)尿源性膿毒血癥的獨立高危因素，，在輸尿管鏡碎石術(shù)圍手術(shù)期要高度重視，積極預(yù)防。 2高齡（70歲）病人雖相關(guān)，但非獨立危險因素 3大體積結(jié)石（1cm）和息肉包裹梗阻不是輸尿管碎石術(shù)后繼發(fā)尿膿毒血癥相關(guān)危險因素。
[Abstract]:Purpose Ureteroscopic lithotripsy secondary to ureteral sepsis is a serious complication. The risk factors of ureteral sepsis associated with ureteroscopic lithotripsy were analyzed, and the characteristics, diagnosis and treatment of ureteroscopic lithotripsy were discussed. Method The clinical data of 642 ureteroscopic lithotripsy patients from July 2009 to July 2013 in Kunshan Hospital of traditional Chinese Medicine were collected. Univariate and multivariate Logistic regression analysis was performed on 37 patients with secondary ureteral sepsis. To find the risk factors for ureteral sepsis secondary to ureteroscopic lithotripsy. Result Among the 1.642 patients with ureteroscopic lithotripsy, 37 cases were secondary ureteral sepsis, the incidence was 5.7. After active treatment, 34 cases were cured, 1 case improved and 2 cases died. 2. Univariate analysis showed that the age of 70 years old, female, diabetes mellitus, before the middle segment of urine bacteria culture positive, the operation time of 1 hour and complicated with urinary sepsis, there was statistical difference (P 0.05). 3. Multivariate analysis showed that: female, diabetes mellitus, positive urine culture before operation, operation time of 1 hour were the independent risk factors of urinary sepsis, there was statistical difference (P 0.05). 4. The size of stone and polyp were not related to secondary urinary sepsis, and there was no statistical difference (P 0.05). Conclusion 1 female, diabetes mellitus, positive urine culture before operation and long operation time (1 hour) are the independent high risk factors of ureteroscopic lithotripsy secondary to ureterogenic sepsis. We should attach great importance to the perioperative period of ureteroscopic lithotripsy and actively prevent it. (2 aged 70 years) although the patient is related, it is not independent risk factor. (3) large volume stone (1 cm) and polyp encapsulated obstruction were not risk factors for secondary urinary sepsis after ureteral lithotripsy.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R459.7;R699.4

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