恒壓灌注下經(jīng)皮腎鏡取石術(shù)后尿源性膿毒血癥危險(xiǎn)因素分析與防治策略
發(fā)布時(shí)間：2018-08-12 16:45
【摘要】：目的:探討恒壓灌注下PCNL術(shù)后尿源性膿毒血癥的危險(xiǎn)因素及防治策略。方法:回顧性分析496例我院行PCNL術(shù)患者的臨床資料。術(shù)中灌注泵壓力均為30kpa,分別對(duì)患者年齡、性別、術(shù)前尿培養(yǎng)、結(jié)石面積、鹿角形結(jié)石、手術(shù)時(shí)間、術(shù)中灌注液體量、狹窄盞頸型結(jié)石與術(shù)后尿源性膿毒血癥發(fā)生率的相關(guān)性進(jìn)行分析。結(jié)果:496例恒壓灌注下行PCNL的患者術(shù)后發(fā)生尿源性膿毒血癥者16例,發(fā)病率為3.2%。單因素分析顯示:尿源性膿毒血癥組在女性、結(jié)石面積(800mm2)、術(shù)前尿培養(yǎng)陽(yáng)性、手術(shù)時(shí)間(90min)、術(shù)中灌注液體量(20L)、狹窄盞頸型結(jié)石這些因素與對(duì)照組比較存在顯著性差異(P0.05)。多因素Logistic回歸分析顯示:術(shù)前尿培養(yǎng)陽(yáng)性、結(jié)石面積(800mm2)、手術(shù)時(shí)間(90min)和狹窄盞頸型結(jié)石是PCNL術(shù)后發(fā)生尿源性膿毒血癥的獨(dú)立危險(xiǎn)因素(P0.05)。結(jié)論:在恒定壓力灌注下,術(shù)前尿培養(yǎng)陽(yáng)性、結(jié)石面積(800mm2)、手術(shù)時(shí)間(90min)、狹窄盞頸型結(jié)石是經(jīng)皮腎鏡取石術(shù)后發(fā)生尿源性膿毒血癥的獨(dú)立危險(xiǎn)因素。此外,女性、灌注液體量20L也與恒壓灌注下PCNL術(shù)后尿源性膿毒血癥發(fā)生有關(guān)。鑒于這些危險(xiǎn)因素的存在,我們應(yīng)該做到:(1)術(shù)前發(fā)現(xiàn)尿培養(yǎng)陽(yáng)性者,應(yīng)積極抗感染治療,必要時(shí)先留置雙J管或腎造瘺管,待感染控制再行手術(shù);女性患者,提高警惕;重視患者的基礎(chǔ)疾病,嚴(yán)格控制病情。(2)術(shù)中應(yīng)嚴(yán)格控制手術(shù)時(shí)間、減少灌注量,必要時(shí)分期手術(shù);處理狹窄盞頸型結(jié)石時(shí),擴(kuò)張盞頸后,盡量將peel-away鞘置入盞內(nèi),保證灌注液回流通暢;酌情應(yīng)用糖皮質(zhì)激素及利尿劑。(3)術(shù)后保證引流通暢。當(dāng)PCNL術(shù)后發(fā)生尿源性膿毒血癥時(shí),立即抗感染及液體復(fù)蘇,病情加重時(shí),還要使用血管活性藥物、縮血管藥物和激素等,盡早轉(zhuǎn)移至ICU治療。
[Abstract]:Objective: to investigate the risk factors and prevention and treatment of urinary sepsis after PCNL under constant pressure perfusion. Methods: the clinical data of 496 PCNL patients in our hospital were analyzed retrospectively. The intraoperative pump pressure was 30 kpa.An age, sex, urine culture before operation, stone area, antler calculi, operative time, intraoperative fluid volume were measured, respectively. The relationship between the incidence of urinal sepsis and the incidence of calyceal stricture calculi was analyzed. Results there were 16 cases of urogenic sepsis after PCNL under constant pressure perfusion in 16 cases, and the incidence was 3.2%. Univariate analysis showed that there were significant differences between female and control group in urogenic sepsis group (800mm2), positive urine culture before operation, operation time (90min), intraoperative fluid volume (20L) and narrow calyceal calculus (P0.05). Multivariate Logistic regression analysis showed that positive urine culture before operation, stone area (800mm2), operation time (90min) and calyceal stricture stone were independent risk factors of urinary sepsis after PCNL (P0.05). Conclusion: under constant pressure perfusion, positive urine culture before operation, stone area (800mm2), operation time (90min) and narrow calyceal calculi are independent risk factors for urogenic sepsis after percutaneous nephrolithotomy. In addition, 20 L perfusion volume in women was also associated with urogenic sepsis after PCNL under constant pressure perfusion. In view of the existence of these risk factors, we should: (1) those who found positive urine culture before operation should be actively treated with anti-infection, if necessary, double J tube or nephrostomy tube should be placed first, and then the infection control should be performed again, and the female patients should be on their guard; Attention should be paid to the basic diseases of the patients and the condition should be strictly controlled. (2) the operative time should be strictly controlled during the operation, the perfusion should be reduced, and the operation should be carried out by stages when necessary, and when the narrow calyceal calculi were treated, the peel-away sheath should be placed into the calyx after dilatation of the calyx neck. Ensure the flow of perfusion fluid unobstructed; use glucocorticoid and diuretic as appropriate. (3) ensure smooth drainage after operation. When urogenic sepsis occurs after PCNL, immediate anti-infection and fluid resuscitation, as well as the use of vasoactive drugs, vasoconstrictors and hormones, should be used to transfer to ICU as soon as possible.
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R699
[Abstract]:Objective: to investigate the risk factors and prevention and treatment of urinary sepsis after PCNL under constant pressure perfusion. Methods: the clinical data of 496 PCNL patients in our hospital were analyzed retrospectively. The intraoperative pump pressure was 30 kpa.An age, sex, urine culture before operation, stone area, antler calculi, operative time, intraoperative fluid volume were measured, respectively. The relationship between the incidence of urinal sepsis and the incidence of calyceal stricture calculi was analyzed. Results there were 16 cases of urogenic sepsis after PCNL under constant pressure perfusion in 16 cases, and the incidence was 3.2%. Univariate analysis showed that there were significant differences between female and control group in urogenic sepsis group (800mm2), positive urine culture before operation, operation time (90min), intraoperative fluid volume (20L) and narrow calyceal calculus (P0.05). Multivariate Logistic regression analysis showed that positive urine culture before operation, stone area (800mm2), operation time (90min) and calyceal stricture stone were independent risk factors of urinary sepsis after PCNL (P0.05). Conclusion: under constant pressure perfusion, positive urine culture before operation, stone area (800mm2), operation time (90min) and narrow calyceal calculi are independent risk factors for urogenic sepsis after percutaneous nephrolithotomy. In addition, 20 L perfusion volume in women was also associated with urogenic sepsis after PCNL under constant pressure perfusion. In view of the existence of these risk factors, we should: (1) those who found positive urine culture before operation should be actively treated with anti-infection, if necessary, double J tube or nephrostomy tube should be placed first, and then the infection control should be performed again, and the female patients should be on their guard; Attention should be paid to the basic diseases of the patients and the condition should be strictly controlled. (2) the operative time should be strictly controlled during the operation, the perfusion should be reduced, and the operation should be carried out by stages when necessary, and when the narrow calyceal calculi were treated, the peel-away sheath should be placed into the calyx after dilatation of the calyx neck. Ensure the flow of perfusion fluid unobstructed; use glucocorticoid and diuretic as appropriate. (3) ensure smooth drainage after operation. When urogenic sepsis occurs after PCNL, immediate anti-infection and fluid resuscitation, as well as the use of vasoactive drugs, vasoconstrictors and hormones, should be used to transfer to ICU as soon as possible.
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R699
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