【摘要】：目的：主要探討尿路感染對URSL術后并發(fā)癥（發(fā)熱，出血，膿毒血癥，腎功能損害）的影響，進一步指導臨床醫(yī)生對此類患者圍手術期的治療。 方法：本文回顧性分析2011年12月～2012年12月我院收治的輸尿管結石患者214例，其中選擇行經尿道輸尿管鏡氣壓彈道碎石術治療的有178例患者，嚴格按照術前是否尿路感染作為分組標準，分為尿路感染組和無尿路感染組,分別對各組是否發(fā)熱、出血、出現(xiàn)膿毒血癥、出現(xiàn)腎功能損害病例數進行統(tǒng)計學分析研究。 結果:尿路感染組62例,無尿路感染組116例,術前尿路感染組中術后發(fā)熱者48例,不發(fā)熱者14例,發(fā)熱者占尿路感染組的77.4%；無尿路感染組術后發(fā)熱者6例,不發(fā)熱者110例，發(fā)熱者占非尿路感染組的5.2%；卡方分析顯示p=0.0000.05,表明尿路感染與術后發(fā)熱有明顯關系。術前尿路感染組中術后出現(xiàn)肉眼血尿者58例,無血尿者4例,出血病例數占到93.5%；無尿路感染組術后出現(xiàn)肉眼血尿者73例,無血尿者43例，出血病例占到62.9%；卡方分析顯示p=0.0010.05,表明尿路感染與術后肉眼血尿有直接關系。術前尿路感染組中術后出現(xiàn)腎功能異常者22例,無腎功能異常者40例,出現(xiàn)腎功能損害病例數占尿路感染組總病例數的35.5%；無尿路感染組術后出現(xiàn)腎功能異常者18例,無腎功能異常者98例，出現(xiàn)腎功能損害病例數占非尿路感染組總病例數的15.5%，；卡方分析顯示p=0.0020.05,表明尿路感染與會影響到術后患者腎功能。術前尿路感染組中術后出現(xiàn)膿毒血癥者4例,未出現(xiàn)者58例,出現(xiàn)膿毒血癥病例數占尿路感染組的6.5%；無尿路感染組術后出現(xiàn)膿毒血癥者2例,未出現(xiàn)者114例，出現(xiàn)膿毒血癥病例數占非尿路感染組的1.7%；卡方分析顯示p=0.0330.05,表明尿路感染與術后尿毒癥的出現(xiàn)有顯著關系。 結論:術前尿路感染與經尿道輸尿管鏡術后并發(fā)癥發(fā)熱、肉眼血尿、膿毒血癥、腎功能異常有直接關系。故行輸尿管鏡手術前，患者需行尿常規(guī)和血常規(guī)檢查，若患者合并感染，，先經驗用藥抗感染治療，后積極行中段尿細菌培養(yǎng)和藥物敏感試驗，明確細菌及敏感藥物后，予以抗感染治療，復查尿常規(guī)，直至患者無尿路感染，以此減少患者術后并發(fā)癥的發(fā)生。
[Abstract]:Objective: to investigate the effect of urinary tract infection on postoperative complications (fever, hemorrhage, sepsis, renal dysfunction) after URSL, and to guide clinicians in the perioperative treatment of these patients. Methods: 214 cases of ureteral calculi treated in our hospital from December 2011 to December 2012 were retrospectively analyzed. 178 cases were treated with transurethral ureteroscopic pneumatic lithotripsy. According to the criteria of urinary tract infection before operation, it was divided into urinary tract infection group and no urinary tract infection group. The number of cases of fever, hemorrhage, sepsis and renal function damage in each group were analyzed statistically. Results: there were 62 cases of urinary tract infection group and 116 cases of no urinary tract infection group. 48 cases of postoperative fever and 14 cases of non-febrile infection were found in pre-operation and post-operation group. The patients with fever accounted for 77.4% of the urinary tract infection group. In the non-urinary tract infection group, there were 6 cases of postoperative fever, 110 cases of no fever, and 5.2% of the non-urinary tract infection group, the chi-square analysis showed that there was a significant relationship between urinary tract infection and postoperative fever. There were 58 cases of naked hematuria, 4 cases of no hematuria, and 93 5 cases of hemorrhage, 73 cases of naked hematuria and 43 cases of no hematuria occurred after operation in the group of infection of urinary tract before and after operation, and the cases of bleeding accounted for 62.9%. Chi-square analysis showed that there was a direct relationship between urinary tract infection and naked hematuria after operation. There were 22 cases of abnormal renal function and 40 cases of no abnormal renal function in the pre-operation and post-operation group. The number of cases with renal function damage accounted for 35.5B in the total cases of urinary tract infection group. In the non-urinary tract infection group, there were 18 cases of abnormal renal function and 98 cases of no abnormal renal function. The number of cases with renal function damage accounted for 15.5% of the total cases of non-urinary tract infection group. Chi-square analysis showed that the presence of urinary tract infection affected the renal function of postoperative patients. There were 4 cases with sepsis and 58 cases without sepsis after operation in the group of urinary tract infection before and after operation. The number of cases with sepsis accounted for 6.5% of that in the group of urinary tract infection. Sepsis occurred in 2 cases and no sepsis in 114 cases in the non-urinary tract infection group. The number of sepsis cases was 1.7% in the non-urinary tract infection group. Chi-square analysis showed that there was a significant relationship between urinary tract infection and postoperative uremia. Conclusion: preoperative urinary tract infection is directly related to complications such as fever, hematuria, sepsis and abnormal renal function after transurethral ureteroscopy. Therefore, before ureteroscopy, patients should perform routine urine examination and blood routine examination. If the patients are complicated with infection, they should be treated with medication and anti-infection first, and then positive bacteria culture and drug sensitivity test should be performed to identify bacteria and sensitive drugs. The patients were treated with anti-infection and urine routine was rechecked until there was no urinary tract infection in order to reduce postoperative complications.
【學位授予單位】：皖南醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R699

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