發(fā)布時間：2018-05-06 18:14

  本文選題：輸尿管氣壓彈道碎石術(shù) + 重癥感染��； 參考：《中華醫(yī)院感染學(xué)雜志》2017年09期

【摘要】：目的探討經(jīng)輸尿管氣壓彈道碎石術(shù)后合并重癥感染的早期診療方法,以減少經(jīng)輸尿管氣壓彈道碎石術(shù)后合并重癥感染的發(fā)生。方法選擇2012年1月-2015年12月收治的260例經(jīng)輸尿管氣壓彈道碎石術(shù)后合并重癥感染患者為研究對象(觀察組),另選同期經(jīng)輸尿管氣壓彈道碎石術(shù)后未發(fā)生感染的患者260例(對照組),比較兩組患者的結(jié)石直徑、尿液檢查情況、術(shù)前感染情況、輸尿管鏡操作時間、手術(shù)時間、術(shù)中出血、術(shù)中灌注壓、術(shù)后引流、碎石成功率及結(jié)石清除率。結(jié)果觀察組術(shù)前結(jié)石15mm和尿液檢查呈陽性的患者(207例、215例)多于對照組(32例、39例),差異有統(tǒng)計學(xué)意義(P0.05);觀察組術(shù)前感染未控制和術(shù)后引流不暢的患者(195例、179例)多于對照組(14例、27例),差異有統(tǒng)計學(xué)意義(P0.05);觀察組手術(shù)時間、輸尿管鏡操作時間[(72.19±14.31)min、(72.07±16.11)min]多于對照組[(65.14±12.01)min、(35.53±14.21)min],觀察組術(shù)中出血量[(24.65±3.27)ml]多于對照組[(18.21±2.32)ml],觀察組術(shù)中灌注壓[(81.28±7.01)mmHg]高于對照組[(65.42±6.73)mmHg],差異有統(tǒng)計學(xué)意義(P0.05);觀察組患者碎石成功率和結(jié)石排除率(77.31%、70.00%)均低于對照組(88.85%、82.31%),差異均有統(tǒng)計學(xué)意義(P0.05)。結(jié)論結(jié)石直徑較大、尿檢陽性、術(shù)前感染未控制、手術(shù)時間過長、輸尿管鏡操作時間、術(shù)中出血量過多、術(shù)中灌注壓過高、術(shù)后引流不暢易導(dǎo)致輸尿管氣壓彈道碎石術(shù)后合并重癥感染發(fā)生,在早期診斷和治療過程中應(yīng)給予有效的抗感染治療,提高碎石技巧以及加強(qiáng)術(shù)后護(hù)理。
[Abstract]:Objective to explore the early diagnosis and treatment of severe infection after transureteral pneumatic lithotripsy, so as to reduce the incidence of severe infection after transureteral pneumatic lithotripsy. Methods 260 patients with severe infection after ureteral pneumatic lithotripsy from January 2012 to December 2015 were selected as study subjects (observation group, no infection after ureteral pneumatic lithotripsy during the same period). The diameter of calculi in the two groups was compared with that in the control group (n = 260). Urine examination, preoperative infection, ureteroscope operation time, operative time, intraoperative bleeding, intraoperative perfusion pressure, postoperative drainage, lithotripsy success rate and stone removal rate. Results the number of patients with positive 15mm and urine examination before operation in the observation group was more than that in the control group (39 cases), the difference was statistically significant (P 0.05), and in the observation group, there were 195 cases (179 cases) with uncontrolled infection before operation and poor drainage after operation. There were more than 14 cases in the control group and 27 cases in the control group, the difference was statistically significant (P 0.05), the time of operation in the observation group was less than that in the control group. The operative time of ureteroscopy [72.19 鹵14.31 16.11)min] was longer than that of control group [65.14 鹵12.01 min], the intraoperative bleeding volume in observation group [24.65 鹵3.27)ml] was longer than that in control group [18.21 鹵2.32)ml], the intraoperative perfusion pressure in observation group [81.28 鹵7.01)mmHg] was higher than that in control group [65.42 鹵6.73)mmHg], the difference was statistically significant (P 0.05), the success rate of lithotripsy and stone removal in observation group was higher than that in control group (P 0.05). 77.31% (P 0.05) were lower than the control group (88.85%, 82.31%), and the difference was statistically significant (P 0.05). Conclusion the stone diameter is larger, urine test is positive, infection before operation is not controlled, operation time is too long, operative time of ureteroscope, blood loss during operation is too much, perfusion pressure is too high during operation. Postoperative drainage is easy to lead to severe infection after ureteral pneumatic lithotripsy. In the early diagnosis and treatment, effective anti-infection treatment should be given, lithotripsy skills should be improved and postoperative nursing should be strengthened.
【作者單位】： 江漢大學(xué)附屬醫(yī)院泌尿外科;
【基金】：湖北省衛(wèi)生廳基金資助項目(WX16E07)
【分類號】：R699.4

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