前列腺癌患者穿刺活检引发感染性休克的影响因素分析
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摘要
目的探讨前列腺癌患者穿刺活检后发生感染性休克的影响因素。方法回顾性分析92例前列腺癌患者的临床资料,根据是否因前列腺穿刺活检发生感染性休克分为休克组(n=9)和正常组(n=83),采用单因素分析和多因素Logistic回归分析研究穿刺活检后发生感染性休克的影响因素。结果 92例患者中,9例(9.78%)患者发生感染性休克。对9例发生感染性休克的患者行细菌鉴定,共检出致病菌12株,大肠埃希菌为感染性休克的主要致病菌。单因素分析结果显示,前列腺癌患者穿刺活检后发生感染性休克与年龄、合并糖尿病、合并前列腺感染、合并尿路感染、危重症评分及多次穿刺有关(P﹤0.05)。多因素Logistic回归分析结果表明,年龄、合并前列腺感染、合并尿路感染及危重症评分是前列腺癌患者穿刺活检后发生感染性休克的独立危险因素(P﹤0.05)。结论前列腺癌穿刺活检引发感染性休克的重要危险因素主要有年龄、合并尿路感染、合并前列腺感染及危重症评分,临床工作者必须认真做好术前、术中和术后的各项工作,从而降低感染性休克的发生率。
Objective To study the factors influencing the occurrence of septic shock in patients with prostate cancer after puncture biopsy. Method 92 cases of prostate cancer patients were retrospectively analyzed, according to the occurrence of septic shock, these patients were stratified as septic shock group(n=9) and normal group(n=83), respectively,the factors influencing the occurrence of septic shock induced by prostate puncture biopsy were investigated by univariate analysis and multivariate Logistic regression analysis. Result Of the 92 patients, 9(9.78%) had septic shock, and 12 strains of pathogens were detected, which mainly was Escherichia coli. The univariate analysis showed that, the occurrence of septic shock in patients with prostate cancer after puncture biopsy was related to age, combined diabetes mellitus, combined prostate infection, combined urinary tract infection, APACHE score and multiple puncture(P<0.05). Multivariate Logistic regression analysis indicated that age, combined prostate infection, combined urinary tract infection and APACHE scores were independent risk factors for septic infection(P<0.05). Conclusion Age, combined prostate infection, combined urinary infection, and APACHE score are independent risk factors of septic shock caused by puncture biopsy for prostate cancer, and thus the preoperative, intraoperative and postoperative work should be strengthened in order to reduce the incidence of septic shock.
Objective To study the factors influencing the occurrence of septic shock in patients with prostate cancer after puncture biopsy. Method 92 cases of prostate cancer patients were retrospectively analyzed, according to the occurrence of septic shock, these patients were stratified as septic shock group(n=9) and normal group(n=83), respectively,the factors influencing the occurrence of septic shock induced by prostate puncture biopsy were investigated by univariate analysis and multivariate Logistic regression analysis. Result Of the 92 patients, 9(9.78%) had septic shock, and 12 strains of pathogens were detected, which mainly was Escherichia coli. The univariate analysis showed that, the occurrence of septic shock in patients with prostate cancer after puncture biopsy was related to age, combined diabetes mellitus, combined prostate infection, combined urinary tract infection, APACHE score and multiple puncture(P<0.05). Multivariate Logistic regression analysis indicated that age, combined prostate infection, combined urinary tract infection and APACHE scores were independent risk factors for septic infection(P<0.05). Conclusion Age, combined prostate infection, combined urinary infection, and APACHE score are independent risk factors of septic shock caused by puncture biopsy for prostate cancer, and thus the preoperative, intraoperative and postoperative work should be strengthened in order to reduce the incidence of septic shock.
引文
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[2]蒋旭平,邵燕强,袁雪峰,等.影像融合引导靶向穿刺对比常规系统穿刺诊断前列腺癌的荟萃分析[J].医学综述,2017,23(5):1006-1012.
[3]代晓明,黄伟.2016重症医学回顾与展望[J].中华危重病急救医学,2017,29(1):1-5.
[4]董家辉,孙杰,曾安,等.老年危重症患者预后预测模型的研究进展[J].中华老年多器官疾病杂志,2017,16(7):540-544.
[5]Carmignani L,Picozzi S,Spinelli M,et al.Bacterial sepsis following prostatic biopsy[J].Int Urol Nephrol,2012,44(4):1055-1063.
[6]Toren P,Razik R,Trachtenberg J.Catmstrophic sepsis and hemorrhage following tansrectal ultrasound guided prostate biopsies[J].Can Urol Assoc J,2010,4(1):E12-E14.
[7]余陈波,高祥勋,陈梓甫,等.前列腺穿刺术后感染并发症分析总结[J].创伤与急诊电子杂志,2016,4(2):95-97.
[8]Zaytoun OM,Anil T,Moussa AS,et al.Morbidity of prostate biopsy after simplified versus complex preparation protocols:assessment of risk factors[J].Urology,2011,77(4):910-914.
[9]李娟,郭广亚,周莉,等.前列腺癌穿刺活检导致感染性休克的原因及预防[J].实用癌症杂志,2015,30(1):115-117.
[10]庄红雨,彭涛,许学敏,等.经直肠前列腺穿刺活检术后并发症的原因分析[J].中国医药,2013,8(12):1754-1757.