發(fā)布時(shí)間：2018-05-19 17:32

  本文選題：腎造口術(shù) + 經(jīng)皮　； 參考：《北京大學(xué)學(xué)報(bào)(醫(yī)學(xué)版)》2016年04期

【摘要】：目的:分析合并糖尿病的尿路結(jié)石患者在經(jīng)皮腎鏡取石(percutaneous nephrolithotomy,PCNL)術(shù)后發(fā)生全身炎癥反應(yīng)綜合征(systemic inflammatory response syndrome,SIRS)的可能危險(xiǎn)因素。方法:回顧北京大學(xué)人民醫(yī)院泌尿外科2006年6月至2015年12月期間,因尿路結(jié)石行PCNL術(shù)且術(shù)前診斷為2型糖尿病的患者資料,分析患者的臨床特征與術(shù)后SIRS之間的相關(guān)性。符合條件的患者共461例,其中男性281例,女性180例,平均年齡57歲,術(shù)后137例(29.7%)患者出現(xiàn)SIRS。根據(jù)術(shù)后是否發(fā)生SIRS,將患者分為兩組,比較兩組患者的各項(xiàng)臨床參數(shù)的差異。結(jié)果:與未發(fā)生SIRS的患者組相比,發(fā)生SIRS的患者組術(shù)前白細(xì)胞計(jì)數(shù)(×109/L)更高[7.76(4.00~17.96)vs.6.31(2.00~17.40),P0.001];術(shù)前血糖(mmol/L)更高[7.30(3.08~19.90)vs.6.40(3.42~16.78),P0.001];手術(shù)時(shí)間(min)更長[75(20~270)vs.60(20~200),P0.001];相應(yīng)的住院時(shí)間(d)也更長[12(2~46)vs.11(3~29),P=0.019]。術(shù)前血糖偏高的患者術(shù)后SIRS的發(fā)生率高于術(shù)前血糖控制在正常范圍內(nèi)的患者[35.1%(100/285)vs.21.0%(37/176),P=0.001];鹿角形結(jié)石的患者術(shù)后SIRS的發(fā)生率高于非鹿角形結(jié)石的患者[38.8%(33/85)vs.27.7%(104/376),P=0.042];術(shù)前合并尿路感染的患者術(shù)后SIRS的發(fā)生率高于無感染患者[36.8%(50/136)vs.26.6%(81/304),P=0.032];兩組間年齡、性別、體重指數(shù)(body mass index,BMI)、術(shù)前血紅蛋白水平、是否輸血、手術(shù)時(shí)間與術(shù)后SIRS發(fā)生率的差異無統(tǒng)計(jì)學(xué)意義。多因素Logistic回歸分析結(jié)果顯示,術(shù)后SIRS發(fā)生與患者的性別、術(shù)前是否合并尿路感染以及是否為鹿角形結(jié)石無顯著相關(guān)性,而與術(shù)前白細(xì)胞計(jì)數(shù)高于正常(OR=3.194,95%CI:1.531~6.666,P=0.002)、手術(shù)時(shí)間大于60 min(OR=1.635,95%CI:1.088~2.456,P=0.018)以及術(shù)前血糖水平有顯著相關(guān)性,術(shù)前血糖控制在正常值范圍內(nèi)(3.3~6.1 mmol/L)的患者與術(shù)前血糖7.1 mmol/L的患者相比,PCNL術(shù)后SIRS的發(fā)生率差異有統(tǒng)計(jì)學(xué)意義。結(jié)論:對于合并2型糖尿病的尿路結(jié)石患者,PCNL術(shù)后SIRS的發(fā)生與患者術(shù)前白細(xì)胞水平、手術(shù)時(shí)間、術(shù)前空腹血糖水平存在顯著相關(guān)性。術(shù)前白細(xì)胞計(jì)數(shù)升高、手術(shù)時(shí)間大于60 min、術(shù)前空腹血糖較高的患者PCNL術(shù)后發(fā)生SIRS的風(fēng)險(xiǎn)增加。
[Abstract]:Objective: to analyze the risk factors of systemic inflammatory response syndrome (systemic inflammatory response syndrome) after percutaneous nephrolithotomy in patients with diabetes mellitus. Methods: from June 2006 to December 2015, the data of patients with type 2 diabetes mellitus diagnosed as type 2 diabetes mellitus by PCNL for urinary calculi were reviewed, and the correlation between clinical features and postoperative SIRS was analyzed. There were 461 eligible patients, including 281 males and 180 females with an average age of 57 years. Patients were divided into two groups according to the occurrence of SIRS. the differences of clinical parameters between the two groups were compared. Results: the preoperative white blood cell count (脳 109 / L) was higher in the patients with SIRS than that in the patients without SIRS [7.764.004.0017.96v s.6.312.000.17.4040P0.001], and the preoperative blood glucose levels were higher (7.30v 3.0819.90vs.6.403.42tir 16.78p0.001); the operative time was longer (7520270vs.602020200); and the corresponding hospitalization time was longer (12246vs.1132929P0.019). The incidence of postoperative SIRS in patients with hyperglycemia before operation was higher than that in patients with normal blood glucose control before operation [35.1b / 100 / 285v s.21.0 / 37 / 176 / P0.001]; the incidence of postoperative SIRS in patients with staghorn calculi was higher than that in patients with non-staghorn calculi [38.8v 33 / 85vs.27.774 / 376P0.042]; the patients with urinary tract infection before operation had a higher incidence of SIRS than those with non-staghorn calculi (38.8v 33 / 85vs.27.774 / 376P0.042); the incidence of postoperative SIRS in patients with staghorn calculi was higher than that in patients with non-staghorn stones. The incidence of SIRS in patients after operation was higher than that in patients without infection [36.8 / 136vs.26.6]. Gender, body mass index, hemoglobin level before operation, blood transfusion, operation time and postoperative SIRS incidence were not significantly different. The results of multivariate Logistic regression analysis showed that there was no significant correlation between the occurrence of SIRS and gender, preoperative urinary tract infection and staghorn calculi. There was a significant correlation between the white blood cell count before operation and the preoperative blood glucose level. The white blood cell count was higher than that before operation (3.194 ~ 95 CI: 1.531C: 6.666P: 0.002), and the operation time was more than 60 min. The mean time of operation was 1.63595% (CI: 1.0882.456C 0.018) and the level of blood glucose before operation was significantly correlated. The incidence of SIRS after PCNL was significantly higher in patients with preoperative blood glucose within normal range of 3.3 鹵6.1 mmol / L than in patients with preoperative glucose of 7.1 mmol/L. Conclusion: the incidence of SIRS in patients with urinary calculi complicated with type 2 diabetes mellitus has a significant correlation with preoperative leukocyte level, operation time and fasting blood glucose level. The preoperative leukocyte count was increased and the operation time was longer than 60 min. The risk of SIRS in patients with high fasting blood glucose was increased after PCNL.
【作者單位】： 北京大學(xué)人民醫(yī)院泌尿外科;
【分類號】：R699

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本文編號：1911015