小剂量地塞米松预防经皮肾镜取石术并发全身炎症反应综合征的疗效观察
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摘要
目的:探讨小剂量地塞米松预防经皮肾镜取石术并发全身炎症反应综合征(SIRS)的疗效。方法:分析2014年5月～2015年8月经皮肾镜取石术资料,其中有SIRS高危因素的54例患者(存在以下任一因素:术前存在尿路感染,结石负荷≥500mm2,术中碎石手术时间≥120min),其中27例在碎石30min时予以静推地塞米松注射液(0.1mg/kg)或碎石超过120min时使用(地塞米松组),另27例术中予常规处理(常规组),比较两组术前年龄、性别,ASA、糖尿病、尿路感染,结石负荷等术前资料,术后监测体温、心率、呼吸、动脉血二氧化碳分压和外周血分析,记录全身炎性反应综合征的发生情况,比较两组并发全身炎症反应综合征的情况。结果:两组患者术前资料对比无明显差异,术后常规组诊断SIRS 7例(25.9%),地塞米松组1例(4%),与常规组相比,地塞米松组术后并发SIRS的发生率更低,差异有统计学意义(P<0.05)。结论:对于SIRS高危患者,经皮肾镜取石术中早期预防性应用小剂量地塞米松能够减少术后SIRS的发生。
Objective:To investigate the preventive effects of low does of dexamethasone on systemic inflammatory responsible syndrome(SIRS)following percutaneous nepholithotomy(PCNL).Methods:From May 2014 to Aug 2015,the clinic data of 54 cases with any high risk factors of SIRS(urinay tract infection,stone burden≥500 mm2 or operation time≥120 min)undergoing PCNL were retrospectively analyzed,and the patients were randomly divided into contro1 group and dexamethasone group(0.1 mg/kg).Results:There was no significant difference in pre-operative clinical data between two groups.There was singnifcant difference in the incidence of SIRS between two groups(25.9%vs.4.0%)(P<0.05).Conclusions:Low does of dexamethasone in PCNL may decrease the incidence of postoperative SIRS.
Objective:To investigate the preventive effects of low does of dexamethasone on systemic inflammatory responsible syndrome(SIRS)following percutaneous nepholithotomy(PCNL).Methods:From May 2014 to Aug 2015,the clinic data of 54 cases with any high risk factors of SIRS(urinay tract infection,stone burden≥500 mm2 or operation time≥120 min)undergoing PCNL were retrospectively analyzed,and the patients were randomly divided into contro1 group and dexamethasone group(0.1 mg/kg).Results:There was no significant difference in pre-operative clinical data between two groups.There was singnifcant difference in the incidence of SIRS between two groups(25.9%vs.4.0%)(P<0.05).Conclusions:Low does of dexamethasone in PCNL may decrease the incidence of postoperative SIRS.
引文
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[2]那彦群,叶章群,孙光,等.中国泌尿外科疾病诊断治疗指南,2011版.北京:人民卫生出版社,2011:296-298.
[3]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.中山大学学报:医学科学版,2016,37(2):295-299.
[4]魏武,葛京平,马宏青,等.经皮肾镜钬激光碎石术全身炎症反应综合征发生的相关因素.临床泌尿外科杂志,2007,22(4):264-266,269.
[5]吴言涛.全身性炎性反应综合征的基础与临床.中国普外基础与临床杂志,2003,10(4):402-404.
[6]刘佛林,邹晓峰,肖日海,等.即刻二期不置肾造瘘管微创经皮肾镜取石术疗效评价.中国内镜杂志,2012,18(10):1050-1053.
[7]邱春兰,王兴勇.全身炎症反应综合征发病机制研究进展.西部医学,2009,21(4):662-663,666.
[8]刘海涛,蒙陆丹,吴曙粤.全身炎症反应综合征和多器官功能障碍综合征早期诊断的实验室预警指标研究进展.内科,2008,3(1):89-91.
[9]陈仙,罗志刚,杨罗艳,等.并发全身炎症反应综合征的经皮肾镜超声碎石术患者危险因素评估.中国现代手术学杂志,2009,13(2):143-146.
[10]傅岳武,陈志强,王树声,等.急性上尿路梗阻全身炎症反应综合征76例临床分析.临床泌尿外科杂志,2002,27(9):469-470.
[11]任建安.糖皮质激素在感染性休克治疗中的应用.中国实用外科杂志,2001,21(6):7-9.
[12]孙昀.糖皮质激素在感染性休克中的应用研究进展.中国急救医学,2014,34(4):297-301.
[13]Minneci PC,Deans KJ,Banks SM,et al.Meta-analysis:the effect of steroids on survival and shock during sepsis depends on the dose.Ann Intern Med,2004,141(1):47-56.
[14]潘国俊,陈淑华.肾上腺皮质激素在脓毒症中的应用——"2012国际严重脓毒症和感染性休克管理指南"解读.医药前沿,2013,20(7):55-56.