本文選題：上尿路結(jié)石　切入點(diǎn)：尿培養(yǎng)　出處：《天津醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：背景和目的尿路結(jié)石是泌尿系統(tǒng)的常見(jiàn)疾病之一,我國(guó)的發(fā)病率為1%-5%。隨著我國(guó)經(jīng)濟(jì)的快速發(fā)展和飲食結(jié)構(gòu)的改變,我國(guó)尿路結(jié)石的發(fā)病率呈逐年上升的趨勢(shì)[1]。尿路結(jié)石按部位可分為上尿路結(jié)石和下尿路結(jié)石,其中上尿路結(jié)石約占80%。經(jīng)皮腎鏡取石術(shù)(PCNL)和輸尿管鏡碎石術(shù)(URSL)已成為上尿路結(jié)石的首選治療方法,明顯提高了結(jié)石治療的安全有效性,但術(shù)后尿源性膿毒血癥仍不能完全避免。國(guó)內(nèi)外諸多報(bào)道認(rèn)為上尿路結(jié)石術(shù)后由菌血癥或膿毒血癥等引起的全身炎癥反應(yīng)綜合征(SIRS)與尿白細(xì)胞含量、手術(shù)時(shí)間、通道個(gè)數(shù)、灌洗液用量和輸血多少等有關(guān),但針對(duì)上尿路結(jié)石中段尿培養(yǎng)細(xì)菌譜的分析及抗生素應(yīng)用的相關(guān)研究較少。由于抗菌藥物的廣泛應(yīng)用和不合理使用,使許多病原菌耐藥性越來(lái)越高,給臨床治療帶來(lái)困難。 方法回顧性分析2012年1月～2013年7月期間天津醫(yī)科大學(xué)總醫(yī)院泌尿外科收治的143例行經(jīng)尿道輸尿管鏡或經(jīng)皮腎鏡碎石取石術(shù)的上尿路結(jié)石患者的臨床資料,所有患者術(shù)前均行中段尿培養(yǎng),陽(yáng)性者58例,且均行抗生素預(yù)防性治療,術(shù)后均監(jiān)測(cè)患者體溫、心率、呼吸及血白細(xì)胞計(jì)數(shù)等與SIRS有關(guān)的指標(biāo)。分析術(shù)前中段尿培養(yǎng)細(xì)菌譜及上尿路結(jié)石患者抗生素的應(yīng)用,并運(yùn)用統(tǒng)計(jì)學(xué)方法對(duì)抗生素使用天數(shù)與SIRS的發(fā)生等關(guān)系進(jìn)行分析。 結(jié)果入組患者143例,58例尿培養(yǎng)陽(yáng)性患者中,術(shù)后出現(xiàn)SIRS者26例,尿培養(yǎng)為革蘭氏陰性菌感染45例(77.59%),革蘭氏陽(yáng)性菌感染13例(22.41%),革蘭氏陰性菌感染中以大腸埃希菌感染最多,為30例(51.72%),其對(duì)多種p-內(nèi)酰胺酶復(fù)合制劑、頭孢西丁等抗菌藥物的耐藥率為3%-10%；革蘭氏陽(yáng)性菌中以糞腸球菌感染最多,為8例(13.79%),其對(duì)呋喃妥因和氨芐西林的敏感性分別為100%和87.5%,未發(fā)現(xiàn)對(duì)萬(wàn)古霉素和替考拉寧耐藥的糞腸球菌和屎腸球菌。術(shù)前尿培養(yǎng)陽(yáng)性患者術(shù)后發(fā)生SIRS的陽(yáng)性率明顯高于術(shù)前尿培養(yǎng)陰性的患者(P0.01),差異有統(tǒng)計(jì)學(xué)意義,針對(duì)上尿路結(jié)石患者預(yù)防性應(yīng)用抗生素3天術(shù)后發(fā)生SIRS的陽(yáng)性率明顯高于應(yīng)用抗生素≥3天的患者(P0.05),差異有統(tǒng)計(jì)學(xué)意義,女性結(jié)石患者和鹿角形結(jié)石患者尿培養(yǎng)陽(yáng)性率相對(duì)較高(P0.05),差異有統(tǒng)計(jì)學(xué)意義。 結(jié)論泌尿系統(tǒng)結(jié)石合并尿路感染(UTI)十分常見(jiàn),結(jié)石、梗阻和積水是一個(gè)相互促進(jìn)的惡性循環(huán)。術(shù)前中.段尿細(xì)菌培養(yǎng)結(jié)果主要以革蘭氏陰性桿菌為主,即大腸埃希菌,p-內(nèi)酰胺酶復(fù)合制劑和頭孢西丁可用于革蘭陰性桿菌的經(jīng)驗(yàn)性抗菌治療。糞腸球菌對(duì)紅霉素、克林霉素、四環(huán)素及喹諾酮類耐藥率較高,不宜作為上尿路結(jié)石合并尿路感染的首選藥物。術(shù)前中段尿培養(yǎng)陽(yáng)性和預(yù)防性使用抗生素不足3天是感染性休克的危險(xiǎn)因素。上尿路結(jié)石患者術(shù)前進(jìn)行中段尿培養(yǎng),且根據(jù)藥敏結(jié)果選用敏感抗生素預(yù)防治療≥3天,對(duì)預(yù)防取石術(shù)后SIRS的發(fā)生具有重要意義。
[Abstract]:Background and objective urinary calculi are one of the common diseases in the urinary system. The incidence of urinary calculi in China is 1-5. With the rapid development of our economy and the change of dietary structure, The incidence of urinary calculi in China is increasing year by year [1] .Urolithiasis can be divided into upper urinary calculi and lower urinary calculi according to their location. Percutaneous nephrolithotomy (PCNL) and ureteroscopic lithotripsy (URSL) have become the first choice for the treatment of upper urinary calculi. However, urinary sepsis can not be avoided completely after operation. Many reports at home and abroad believe that the systemic inflammatory response syndrome (SIRSs) caused by bacteremia or sepsis after upper urinary tract calculi is associated with urinary white blood cell content, operation time, and the number of channels. The amount of lavage fluid was related to the amount of blood transfusion, but there were few studies on bacterial spectrum analysis and antibiotic application in the middle part of upper urinary tract stone, due to the extensive use and irrational use of antimicrobial agents. Many pathogens become more and more resistant, which brings difficulties to clinical treatment. Methods the clinical data of 143 patients with upper urinary calculi treated by transurethral ureteroscopy or percutaneous nephrolithotomy from January 2012 to July 2013 in General Hospital of Tianjin Medical University were retrospectively analyzed. All the patients were treated with midstream urine culture before operation, 58 cases were positive, and all of them were treated with antibiotic prophylactic therapy. The body temperature and heart rate were monitored after operation. Respiratory and white blood cell count were related to SIRS. The bacterial spectrum of urine culture and the application of antibiotics in patients with upper urinary calculi before operation were analyzed. The relationship between the days of antibiotic use and the occurrence of SIRS was analyzed by statistical method. Results of the 143 patients with positive urine culture, 26 had SIRS, 45 had Gram-negative bacteria infection, 13 had Gram-positive bacteria infection, and the most common Gram-negative bacteria infection was Escherichia coli. The resistance rate of cefxitin and other antimicrobial agents to various kinds of plactamases was 3- 10. Among Gram-positive bacteria, Enterococcus faecalis infection was the most. The sensitivity to furantoin and ampicillin were 100% and 87.5, respectively. No vancomycin and teicoplanin resistant Enterococcus faecalis and Enterococcus faecium were found. The positive rate of SIRS in patients with positive urine culture before and after operation was clear. It was significantly higher than that of patients with negative urine culture before operation (P 0.01), and the difference was statistically significant. The positive rate of SIRS in patients with upper urinary calculi after 3 days of prophylactic antibiotic application was significantly higher than that in patients with upper urinary calculi 鈮，

本文編號(hào)：1621990