本文選題：腎結(jié)石　切入點：膿腎經(jīng)皮腎鏡全身炎癥反應(yīng)綜合征危險因素　出處：《四川大學(xué)學(xué)報(醫(yī)學(xué)版)》2017年05期 　論文類型：期刊論文

【摘要】：目的分析結(jié)石性膿腎患者感染特點和經(jīng)皮腎鏡碎石術(shù)(percutaneous nephrolithotomy,PCNL)后發(fā)生全身炎癥反應(yīng)綜合征(systemic inflammatory respo-nse syndrome,SIRS)的相關(guān)危險因素。方法回顧性分析我院2011年1月至2015年12月收治的所有術(shù)前7d無發(fā)熱的結(jié)石性膿腎患者PCNL手術(shù)資料。統(tǒng)計并分析患者術(shù)前尿培養(yǎng)常見病原菌的種類特點、比例和耐藥性。同時用多因素logistic回歸分析患者年齡、性別、術(shù)前尿培養(yǎng)、術(shù)前抗生素使用≥3d、鹿角形結(jié)石、手術(shù)時間等14個因素對患者術(shù)后SIRS的影響。結(jié)果共納入69例結(jié)石性膿腎患者,術(shù)前尿培養(yǎng)共分離出47株病原菌,以大腸埃希菌(30例)、奇異變形桿菌(8例)等革蘭陰性桿菌(G-桿菌)為主。多數(shù)G-桿菌主要對頭霉素類、哌拉西林/他唑巴坦、頭孢哌酮/舒巴坦及碳青霉烯類等藥物敏感。術(shù)后21例(30.4%)患者發(fā)生SIRS,多因素logistic回歸顯示:手術(shù)時間≥60min[標(biāo)準(zhǔn)偏回歸系數(shù)(Beta)=0.378,比值比(OR)=4.483,95%可信區(qū)間(CI)1.111~18.100,P=0.035]為結(jié)石性膿腎PCNL術(shù)后發(fā)生SIRS的獨立危險因素,術(shù)前使用抗生素≥3d(Beta=-0.450,OR=0.194,95%CI 0.051~0.741,P=0.017)和術(shù)前使用敏感抗菌藥物(Beta=-0.610,OR=0.102,95%CI0.017~0.602,P=0.012)兩個因素能降低SIRS的發(fā)生。一期手術(shù)與二期手術(shù)兩組患者的清石率及術(shù)后發(fā)生SIRS、出血等相關(guān)并發(fā)癥發(fā)生率的差異無統(tǒng)計學(xué)意義。二期手術(shù)可降低術(shù)后住院時間(P=0.047),但總住院時間較一期組延長(P0.001)。結(jié)論結(jié)石性膿腎患者術(shù)前尿培養(yǎng)病原菌以G-桿菌為主,且耐藥率高。一期PCNL治療結(jié)石性膿腎安全有效,減少手術(shù)時間并術(shù)前使用敏感抗菌藥物治療≥3d可有效降低SIRS發(fā)生風(fēng)險。
[Abstract]:Objective to analyze the characteristics of infection in patients with calculous pyonephrosis and percutaneous nephrolithotomy (percutaneous nephrolithotomy, PCNL) after the occurrence of systemic inflammatory response syndrome (systemic inflammatory respo-nse syndrome, SIRS) and the related risk factors. Methods a retrospective analysis of all patients with 7d without fever in our hospital from January 2011 to December 2015 were the patients with calculous pyonephrosis the PCNL operation data. And statistical analysis of preoperative urine culture characteristics of pathogenic bacteria and drug resistance. At the same time, the proportion of using multivariate logistic regression analysis with age, gender, preoperative urine culture, the use of antibiotics was 3D before surgery, staghorn calculi, operation time and the influence of 14 factors on SIRS patients after the results of the 69 cases of calculous pyonephrosis were included with preoperative urine cultures were isolated 47 strains of pathogenic bacteria, Escherichia coli (30 cases), Proteus mirabilis (8 cases) and gram negative bacilli ( G-). The majority of G- coli bacilli cephamycins, piperacillin / tazobactam, Cefoperazone / sulbactam and carbapenem sensitive drug. 21 cases after surgery (30.4%) patients with SIRS, multi factor Logistic regression analysis showed that: the operation time was more than 60min[standard partial regression coefficient (Beta) =0.378, the odds ratio (OR) =4.483,95% confidence interval (CI) 1.111~18.100, P=0.035] as independent risk factors for calculous pyonephrosis after PCNL SIRS, the use of antibiotics before surgery (Beta=-0.450 = 3D, OR=0.194,95%CI 0.051~0.741, P=0.017) and preoperative use of antibiotics (Beta=-0.610, OR=0.102,95%CI0.017~0.602, P=0.012) two factors can be reduced the occurrence of SIRS. SIRS and stone clearance rate of one stage surgery and two stage operation of the two groups of patients, bleeding and other complications related to the difference was not statistically significant. The two stage operation can reduce the postoperative hospitalization time (P=0.047), but The total hospitalization time over a period of Yanchang Formation (P0.001). Conclusion calculous pyonephrosis patients urine culture pathogenic bacteria in G- bacteria, and the resistance rate is high. A period of PCNL in the treatment of calculous pyonephrosis is safe and effective, reduce the operation time and preoperative use of sensitive antimicrobial agents than 3D can effectively reduce the occurrence of SIRS the risk.

【作者單位】： 四川大學(xué)華西醫(yī)院泌尿外科;
【分類號】：R699

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