经皮肾镜碎石术后发热的相关因素分析
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摘要
目的探讨经皮肾镜碎石术(PCNL)治疗肾结石术后引起发热的相关因素及防治措施。方法回顾性分析2015年1月-2017年6月该院应用PCNL治疗150例肾结石患者的临床资料,包括年龄、性别、合并糖尿病病史、既往同侧肾脏手术史、结石类型、结石最长径、有无并发输尿管上段结石、术前泌尿系感染、肾积水程度、术前肾盂积脓、术前肾造瘘管的使用、术后中心静脉压、术中灌注量和手术时间,术后分为发热组和未发热组,对两组PCNL术后发热的相关因素进行分析。结果术后发热共27例,占18.0%。性别比例、糖尿病病史、铸型结石或鹿角形结石、结石长径、合并输尿管上段结石、术前尿常规白细胞计数、脓肾、术前使用肾造瘘管、术后中心静脉压、术中灌注量和手术时间在两组间比较,差异均有统计学意义(P<0.05);Logistic多因素分析显示,女性患者、合并输尿管上段结石、术中灌注量、术前肾积脓、手术时间长是术后发热的独立危险因素(OR>1,P<0.05)。结论 PCNL术前需常规尿细菌培养,彻底治疗尿路感染和肾脏积脓,合理控制手术时间和灌注液量,以降低术后患者发热的发生率。
Objective To evaluate and study percutaneous nephrolithotomy(PCNL) related factors in the treatment of renal calculi caused postoperative fever and its prevention measures. Methods Making a retrospective analysis of the clinical records of 150 patients who underwent PCNL, including age, gender, diabetes history and previous ipsilateral renal surgery, stone type, stone size, whether the complication of upper ureteral stones, preoperative urinary tract infection, hydronephrosis and pyonephrosis, preoperative renal fistula, postoperative centering vein pressure, intraoperative perfusion and the operation time from January 2015 to June 2017. After the operation, the patients were divided into two groups: fever group and non-fever group, and analyzed the related factors of the fever. Results Among the 150 cases, fever occurred in 27 cases after PCNL, taking up 18%. Gender, history of diabetes, staghorn calculi or staghorn stone, stone size, with ureteral calculi, preoperative urine leukocyte count, renal abscess, preoperative renal fistula, postoperative central venous pressure, intraoperative perfusion and operation time between the two groups, the differences that were statistically significant(P < 0.05). Logistic that multivariate analysis showed that female patients with upper ureteral calculi, perfusion, intraoperative volume,preoperative pyonephrosis, long operation time are independent risk factors of fever after operation(OR>1, P < 0.05). Conclusion Routine bacterial culture of urine should be performed before percutaneous nephrolithotomy, urinary tract infection and kidney empyema should be treated thoroughly. The reasonable shorter operative duration and perfusion fluid volume could significantly reduce the incidence of fever after PCNL.
Objective To evaluate and study percutaneous nephrolithotomy(PCNL) related factors in the treatment of renal calculi caused postoperative fever and its prevention measures. Methods Making a retrospective analysis of the clinical records of 150 patients who underwent PCNL, including age, gender, diabetes history and previous ipsilateral renal surgery, stone type, stone size, whether the complication of upper ureteral stones, preoperative urinary tract infection, hydronephrosis and pyonephrosis, preoperative renal fistula, postoperative centering vein pressure, intraoperative perfusion and the operation time from January 2015 to June 2017. After the operation, the patients were divided into two groups: fever group and non-fever group, and analyzed the related factors of the fever. Results Among the 150 cases, fever occurred in 27 cases after PCNL, taking up 18%. Gender, history of diabetes, staghorn calculi or staghorn stone, stone size, with ureteral calculi, preoperative urine leukocyte count, renal abscess, preoperative renal fistula, postoperative central venous pressure, intraoperative perfusion and operation time between the two groups, the differences that were statistically significant(P < 0.05). Logistic that multivariate analysis showed that female patients with upper ureteral calculi, perfusion, intraoperative volume,preoperative pyonephrosis, long operation time are independent risk factors of fever after operation(OR>1, P < 0.05). Conclusion Routine bacterial culture of urine should be performed before percutaneous nephrolithotomy, urinary tract infection and kidney empyema should be treated thoroughly. The reasonable shorter operative duration and perfusion fluid volume could significantly reduce the incidence of fever after PCNL.
引文
[1]陈金洋.PCNL术后感染相关因素研究及术前预防应用抗生素的系统评价[D].湖南:南华大学,2010.CHEN J Y.Factors affecting fever following Mini-Percutaneous nepherolithotomy[D].Hunan:University of South China,2010.Chinese
[2]王家勇.微创经皮肾镜碎石取石术后发热的相关危险因素分析[J].中国实用医刊,2016.43(22):114-115.WANG J Y.Analysis of risk factors associated with fever after minimally invasive percutaneous nephrolithotomy[J].Chinese Journal of Practical Medicine,2016.43(22):114-115.Chinese
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[4]谢旭敏.经皮肾镜碎石术所致尿源性脓毒血症的危险因素分析[D].广州:南方医科大学,2015.XIE X M.Analysis of risk factors of urosepsis owing to percutaneous nephrolithotomy[D].Guangzhou:University of Southern Medical,2015.Chinese
[5]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.
[6]DESAI M,DE LISA A,TURNA B,et al.The clinical research office of the endourological society percutaneous nephrolithotomy global study:staghorn versus nonstaghorn stones[J].J Endourol,2011,25(8):1263-1268.
[7]MARIAPPAN P,SMITH G,BARIOL S V,et al.Stone and pelvic urine culture and sensitivity are better than bladder urine as predictors of urosepsis following percutaneous nephrolithotomy:a prospective clinical study[J].J Urol,2005,173(5):1610-1614.
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[9]JOU Y C,LU C L,CHEN F H,et al.Contributing factors for fever after tubeless percutaneous nephrolithotomy[J].Urology,2015,85(3):527-530.
[10]DO?AN H S,SAHIN A,CETINKAYA Y,et al.Antibiotic prophylaxis in percutaneous nephrolithotomy:prospective study in 81 patients[J].J Endourol,2002,16(9):649-653.
[11]洪钟亮,江明友,万明发,等.上尿路结石碎石取石术后发热的相关因素分析[J].浙江创伤外科,2012,17(6):766-767.HONG Z L,JIANG M Y,WAN M F,et al.Analysis of the related factors of fever after stone lithotripsy in upper urinary tract[J].Zhejiang Journal of Traumatic Surgery,2012,17(6):766-767.Chinese
[12]张赟,朴奇彦,王永刚,等.经皮肾镜取石术后发热相关因素分析[J].临床泌尿外科杂志,2011,26(4):290-291.ZHANG Y,PIAO Q Y,WANG Y G,et al.The analyis of infection after percuaneous nehrolithotoy[J].Journal of Clinical Urology,2011,26(4):290-291.Chinese
[13]GONEN M,TURAN H,OZTURK B,et al.Factors affecting fever following percutaneous nephrolithotomy:a prospective clinical study[J].J Endourol,2008,22(9):2135-2138.
[14]刘妍,吴臣,孙涛,等.中文版女性排尿行为量表的信效度检验[J].护理学杂志,2012,27(16):78-80.LIU Y,WU C,SUN T,et al.Reliability and validity of the Chinese Version of Women′s Toileting Behavior Scale:testing in community urinary incontinence women[J].Journal of Nursing Science,2012,27(16):78-80.Chinese
[15]乔庐东,陈山.大肠埃希菌诱发尿路感染发病机制的研究进展[J].中华泌尿外科杂志,2014,35(1):70-72.QIAO L D,CHEN S.Progress in pathogenesis of urinary tract infection induced by Escherichia coli[J].Chinese Journal of Urology,2014,35(1):70-72.Chinese
[16]吴海洋,张志根,李新德,等.上尿路腔内碎石术后急性感染性休克10例报告[J].中华泌尿外科杂志,2013,34(2):157-158.WU H Y,ZHANG Z G,LI X D,et al.Report of 10 cases of acute septic shock after upper urinary tract endoscopic lithotripsy[J].Chinese Journal of Urology,2013,34(2):157-158.Chinese
[17]王炎,林峰,翁雪云,等.加味健脾益肾方辅助经皮肾镜联合钬激光治疗铸型肾结石40例临床观察[J].中医药导报,2015,21(16):29-31.WANG Y,LING F,WENG X Y,et al.Clinical observation of 40cases of jiawei jianpi yishen decoction combined with pcnl using holmium laser lithotrity on cast renal calculus[J].Guiding Journal of Traditional Chinese Medicine and Pharmacology,2015,21(16):29-31.Chinese
[2]王家勇.微创经皮肾镜碎石取石术后发热的相关危险因素分析[J].中国实用医刊,2016.43(22):114-115.WANG J Y.Analysis of risk factors associated with fever after minimally invasive percutaneous nephrolithotomy[J].Chinese Journal of Practical Medicine,2016.43(22):114-115.Chinese
[3]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.
[4]谢旭敏.经皮肾镜碎石术所致尿源性脓毒血症的危险因素分析[D].广州:南方医科大学,2015.XIE X M.Analysis of risk factors of urosepsis owing to percutaneous nephrolithotomy[D].Guangzhou:University of Southern Medical,2015.Chinese
[5]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.
[6]DESAI M,DE LISA A,TURNA B,et al.The clinical research office of the endourological society percutaneous nephrolithotomy global study:staghorn versus nonstaghorn stones[J].J Endourol,2011,25(8):1263-1268.
[7]MARIAPPAN P,SMITH G,BARIOL S V,et al.Stone and pelvic urine culture and sensitivity are better than bladder urine as predictors of urosepsis following percutaneous nephrolithotomy:a prospective clinical study[J].J Urol,2005,173(5):1610-1614.
[8]SHARIFI AGHDAS F,AKHAVIZADEGAN H,ARYANPOOR A,et al.Fever after percutaneous nephrolithotomy:contributing factors[J].Surg Infect(Larchmt),2006,7(4):367-371.
[9]JOU Y C,LU C L,CHEN F H,et al.Contributing factors for fever after tubeless percutaneous nephrolithotomy[J].Urology,2015,85(3):527-530.
[10]DO?AN H S,SAHIN A,CETINKAYA Y,et al.Antibiotic prophylaxis in percutaneous nephrolithotomy:prospective study in 81 patients[J].J Endourol,2002,16(9):649-653.
[11]洪钟亮,江明友,万明发,等.上尿路结石碎石取石术后发热的相关因素分析[J].浙江创伤外科,2012,17(6):766-767.HONG Z L,JIANG M Y,WAN M F,et al.Analysis of the related factors of fever after stone lithotripsy in upper urinary tract[J].Zhejiang Journal of Traumatic Surgery,2012,17(6):766-767.Chinese
[12]张赟,朴奇彦,王永刚,等.经皮肾镜取石术后发热相关因素分析[J].临床泌尿外科杂志,2011,26(4):290-291.ZHANG Y,PIAO Q Y,WANG Y G,et al.The analyis of infection after percuaneous nehrolithotoy[J].Journal of Clinical Urology,2011,26(4):290-291.Chinese
[13]GONEN M,TURAN H,OZTURK B,et al.Factors affecting fever following percutaneous nephrolithotomy:a prospective clinical study[J].J Endourol,2008,22(9):2135-2138.
[14]刘妍,吴臣,孙涛,等.中文版女性排尿行为量表的信效度检验[J].护理学杂志,2012,27(16):78-80.LIU Y,WU C,SUN T,et al.Reliability and validity of the Chinese Version of Women′s Toileting Behavior Scale:testing in community urinary incontinence women[J].Journal of Nursing Science,2012,27(16):78-80.Chinese
[15]乔庐东,陈山.大肠埃希菌诱发尿路感染发病机制的研究进展[J].中华泌尿外科杂志,2014,35(1):70-72.QIAO L D,CHEN S.Progress in pathogenesis of urinary tract infection induced by Escherichia coli[J].Chinese Journal of Urology,2014,35(1):70-72.Chinese
[16]吴海洋,张志根,李新德,等.上尿路腔内碎石术后急性感染性休克10例报告[J].中华泌尿外科杂志,2013,34(2):157-158.WU H Y,ZHANG Z G,LI X D,et al.Report of 10 cases of acute septic shock after upper urinary tract endoscopic lithotripsy[J].Chinese Journal of Urology,2013,34(2):157-158.Chinese
[17]王炎,林峰,翁雪云,等.加味健脾益肾方辅助经皮肾镜联合钬激光治疗铸型肾结石40例临床观察[J].中医药导报,2015,21(16):29-31.WANG Y,LING F,WENG X Y,et al.Clinical observation of 40cases of jiawei jianpi yishen decoction combined with pcnl using holmium laser lithotrity on cast renal calculus[J].Guiding Journal of Traditional Chinese Medicine and Pharmacology,2015,21(16):29-31.Chinese