经皮肾镜取石术后发热及全身炎症反应综合征单中心187例经验分析
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摘要
目的:研究经皮肾镜取石术(PCNL)后发生发热及全身炎症反应综合征(SIRS)的原因及诊治经验,并指导临床早期发现,及时干预,提高围手术期安全。方法:回顾性分析北京大学第一医院泌尿外科2015年11月～2016年10月行PCNL的187例患者的临床资料,采用SymbolcA@~2检验和多因素Logistic回归分析的统计学方法,研究术后出现发热和SIRS与患者的年龄、性别、是否合并糖尿病、是否为鹿角形结石、是否患肾积水、术前是否合并尿路感染、术前麻醉ASA分级、手术时间、术后有无残石的关系。结果:187例患者,术后发热25例(13.4%),术后SIRS 19例(10.2%)。研究发现,女性和术前无肾积水与术后发热相关(P<0.05);术前尿路感染、术前无肾积水与术后SIRS相关(P<0.05);多因素Logistic回归分析提示,女性和术前无肾积水是术后发热的危险因素(P<0.05),术前无肾积水是术后SIRS的危险因素(P<0.05)。结论:发热和SIRS都是PCNL术后常见的并发症,术前无肾积水的患者术后发生发热和SIRS的风险增加,而女性患者更易在术后出现发热反应。
Objective: To evaluate the cause of fever and systemic inflammatory response syndrome(SIRS) after percutaneous nephrolithotomy(PCNL) and its experience of management, and provide guidance of early diagnosis and proper treatment, improve perioperative safety. Method: Medical files of 187 patients to whom a PCNL operation was performed in First Hospital of Peking University between Nov. in 2015 and Oct. in 2016 were reviewed. Chi square test and logistic regression analysis were applied to study the risk factors of fever and SIRS, and make the research from the factors of gender, age, diabetes mellitus, staghorn stone, hydronephrosis, urinary tract infection(UTI), ASA score, operative time and residual stone, to assess statistical association with the fever and SIRS. Result: There were 187 patients in this study. The postoperative fever occurred in 25 patients with the incidence of 13.4%, and there were 19 patients who were diagnosed with SIRS with the incidence of 10.2%. In the Chi square test, we found that gender and hydronephrosis were associated with the postoperative fever(P<0.05), and the UTI and hydronephrosis were associated with the postoperative SIRS(P<0.05). The logistic regression analysis found female and no hydronephrosis were the risk factors of the postoperative fever(P<0.05), and no hydronephrosis was also significantly correlated with the postoperative SIRS(P<0.05). Conclusion: Post-PCNL fever and SIRS were the common complications, and no hydronephrosis is an important factor indicating the development of postoperative fever and SIRS. Female patients have a higher frequency of postoperative fever.
Objective: To evaluate the cause of fever and systemic inflammatory response syndrome(SIRS) after percutaneous nephrolithotomy(PCNL) and its experience of management, and provide guidance of early diagnosis and proper treatment, improve perioperative safety. Method: Medical files of 187 patients to whom a PCNL operation was performed in First Hospital of Peking University between Nov. in 2015 and Oct. in 2016 were reviewed. Chi square test and logistic regression analysis were applied to study the risk factors of fever and SIRS, and make the research from the factors of gender, age, diabetes mellitus, staghorn stone, hydronephrosis, urinary tract infection(UTI), ASA score, operative time and residual stone, to assess statistical association with the fever and SIRS. Result: There were 187 patients in this study. The postoperative fever occurred in 25 patients with the incidence of 13.4%, and there were 19 patients who were diagnosed with SIRS with the incidence of 10.2%. In the Chi square test, we found that gender and hydronephrosis were associated with the postoperative fever(P<0.05), and the UTI and hydronephrosis were associated with the postoperative SIRS(P<0.05). The logistic regression analysis found female and no hydronephrosis were the risk factors of the postoperative fever(P<0.05), and no hydronephrosis was also significantly correlated with the postoperative SIRS(P<0.05). Conclusion: Post-PCNL fever and SIRS were the common complications, and no hydronephrosis is an important factor indicating the development of postoperative fever and SIRS. Female patients have a higher frequency of postoperative fever.
引文
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2王刚.泌尿系结石微创治疗进展[J].中国临床医生,2011,39(2):8-10.
3徐勋,胡明,张湛英,等.经皮肾镜下超声联合气压弹道碎石术治疗肾及输尿管上段结石的疗效分析(附1057例报告)[J].临床泌尿外科杂志,2015,30(1):49-51.
4 Draga R O,Kok E T,Sorel M R,et al.Percutaneous Nephrolithotomy:Factors Associated with Fever After the First Postoperative Day and Systemic Inflammatory Response Syndrome[J].J Endourol,2009,23(6):921-927.
5 Sharifi A F,Akhavizadegan H,Aryanpoor A,et al.Fever after percutaneous nephrolithotomy:contributing factors[J].Surg Infect(Larchmt),2006,7(4):367-371.
6钱庆鹏,张晓春,那彦群.经皮肾镜取石术的并发症与对策[J].临床泌尿外科杂志,2007,22(7):491-493.
7 Gonen M,Turan H,Ozturk B,et al.Factors affecting fever following percutaneous nephrolithotomy:aprospective clinical study[J].J Endourol,2008,22(9):2135-2138.
8李东升,杨彦峰,李亚飞,等.经皮肾镜取石术后全身炎症反应综合征的危险因素分析[J].临床泌尿外科杂志,2015,30(4):335-338,341.
9 Egilmez T.Fever and Systemic Inflammatory Response Syndrome Seen After Percutaneous Nephrolithotomy:Review of 1290Adult Patients[J].J Clin and Analytical Med,2015,6(2):196-201.
10 Gutierrez J,Smith A,Geavlete P,et al.Urinary tract infections and post-operative fever in percutaneous nephrolithotomy[J].World J Urol,2013,31(5):1135-1140.
11 Kumar S,Bag S,Ganesamoni R,et al.Risk factors for urosepsis following percutaneous nephrolithotomy:role of 1 week of nitrofurantoin in reducing the risk of urosepsis[J].Urol Res,2012,40(1):79-86.
12周少丽,邓颖青,谭芳,等.经皮肾镜碎石取石术后全身炎症反应综合征的风险因素回顾性分析[J].中山大学学报(医学科学版),2016,37(2):295-299.
13Singh P,Yadav S,Singh A,et al.Systemic Inflammatory Response Syndrome Following Percutaneous Nephrolithotomy:Assessment of Risk Factors and Their Impact on Patient Outcomes[J].Urol Int,2016,96(2):207-211.
14 Erdil T,Bostanci Y,Ozden E,et al.Risk factors for systemic inflammatory response syndrome following percutaneous nephrolithotomy[J].Urolithiasis,2013,41(5):395-401.
2王刚.泌尿系结石微创治疗进展[J].中国临床医生,2011,39(2):8-10.
3徐勋,胡明,张湛英,等.经皮肾镜下超声联合气压弹道碎石术治疗肾及输尿管上段结石的疗效分析(附1057例报告)[J].临床泌尿外科杂志,2015,30(1):49-51.
4 Draga R O,Kok E T,Sorel M R,et al.Percutaneous Nephrolithotomy:Factors Associated with Fever After the First Postoperative Day and Systemic Inflammatory Response Syndrome[J].J Endourol,2009,23(6):921-927.
5 Sharifi A F,Akhavizadegan H,Aryanpoor A,et al.Fever after percutaneous nephrolithotomy:contributing factors[J].Surg Infect(Larchmt),2006,7(4):367-371.
6钱庆鹏,张晓春,那彦群.经皮肾镜取石术的并发症与对策[J].临床泌尿外科杂志,2007,22(7):491-493.
7 Gonen M,Turan H,Ozturk B,et al.Factors affecting fever following percutaneous nephrolithotomy:aprospective clinical study[J].J Endourol,2008,22(9):2135-2138.
8李东升,杨彦峰,李亚飞,等.经皮肾镜取石术后全身炎症反应综合征的危险因素分析[J].临床泌尿外科杂志,2015,30(4):335-338,341.
9 Egilmez T.Fever and Systemic Inflammatory Response Syndrome Seen After Percutaneous Nephrolithotomy:Review of 1290Adult Patients[J].J Clin and Analytical Med,2015,6(2):196-201.
10 Gutierrez J,Smith A,Geavlete P,et al.Urinary tract infections and post-operative fever in percutaneous nephrolithotomy[J].World J Urol,2013,31(5):1135-1140.
11 Kumar S,Bag S,Ganesamoni R,et al.Risk factors for urosepsis following percutaneous nephrolithotomy:role of 1 week of nitrofurantoin in reducing the risk of urosepsis[J].Urol Res,2012,40(1):79-86.
12周少丽,邓颖青,谭芳,等.经皮肾镜碎石取石术后全身炎症反应综合征的风险因素回顾性分析[J].中山大学学报(医学科学版),2016,37(2):295-299.
13Singh P,Yadav S,Singh A,et al.Systemic Inflammatory Response Syndrome Following Percutaneous Nephrolithotomy:Assessment of Risk Factors and Their Impact on Patient Outcomes[J].Urol Int,2016,96(2):207-211.
14 Erdil T,Bostanci Y,Ozden E,et al.Risk factors for systemic inflammatory response syndrome following percutaneous nephrolithotomy[J].Urolithiasis,2013,41(5):395-401.