经皮肾镜术后尿源性脓毒血症相关危险因素的Meta分析
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摘要
目的分析经皮肾镜碎石取石术(PCNL)术后并发尿源性脓毒血症术前相关危险因素。方法运用Meta分析方法综合分析2006年1月至2016年12月PCNL术后尿源性脓毒血症相关危险因素的研究文献。结果共筛选出相关文献18篇,经分析结果显示有9个危险因素差异具有统计学意义(P<0.05),其OR值及95%CI分别为:女性3.89(2.07,7.31);年龄(≥60岁)1.71(1.23,2.39);糖尿病3.15(2.10,4.72);血常规(白细胞≥10×10~9/L)2.86 (1.66,4.92);尿常规(白细胞≥+)2.43(1.35,4.37);尿培养(阳性)1.60(1.12,2.29);结石大小(≥2 cm)1.94(1.49,2.54);鹿角形结石3.07(1.78,5.31);肾积水(中重度)1.57(1.02,2.43)。结论高龄(≥60岁)、女性、合并糖尿病或术前感染、结石≥2 cm、鹿角形结石、肾积水较重的患者PCNL术后更易发生尿源性脓毒血症。
Objective To analyze the preoperative risk factors related to urosepsis after percutaneous nephrolithotomy. Methods Related literatures about risk factors of urosepsis after percutaneous nephrolithotomy from January 2006 to December 2016 were explored by meta-analysis.Results Eighty studies were selected for meta-analysis, and 9 factors had statistical significances(P<0.0.5). Urosepsis-related factors were as follows: female OR=3.89 [95%CI(2.07, 7.31)], age(≥60 Y) OR=1.71 [95%CI(1.23, 2.39)], diabetes mellitus OR=3.15 [95%CI(2.10, 4.72)], blood routine(White blood cells≥10×10~9/L) OR=2.86 [95%CI(1.66, 4.92)], urine routine(White blood cells≥+)OR=2.43[95%CI(1.35, 4.37)], urobacterial culture(Positive) OR=1.60 [95%CI(1.12, 2.29)], stone size(≥2 cm)OR=1.94 [95%CI(1.49, 2.54)], staghorn stone OR=3.07 [95%CI(1.78, 5.31)], hydronephrosis(moderatesevere) OR=1.57 [95%CI(1.02, 2.43)]. Conclusions Patients who were female, ≥60 years old, with diabetes mellitus, or preoperative infection history, larger stones(≥2 cm), staghorn stone or heavy renal hydroponectomy are more likely to have urosepsis after PCNL surgery.
Objective To analyze the preoperative risk factors related to urosepsis after percutaneous nephrolithotomy. Methods Related literatures about risk factors of urosepsis after percutaneous nephrolithotomy from January 2006 to December 2016 were explored by meta-analysis.Results Eighty studies were selected for meta-analysis, and 9 factors had statistical significances(P<0.0.5). Urosepsis-related factors were as follows: female OR=3.89 [95%CI(2.07, 7.31)], age(≥60 Y) OR=1.71 [95%CI(1.23, 2.39)], diabetes mellitus OR=3.15 [95%CI(2.10, 4.72)], blood routine(White blood cells≥10×10~9/L) OR=2.86 [95%CI(1.66, 4.92)], urine routine(White blood cells≥+)OR=2.43[95%CI(1.35, 4.37)], urobacterial culture(Positive) OR=1.60 [95%CI(1.12, 2.29)], stone size(≥2 cm)OR=1.94 [95%CI(1.49, 2.54)], staghorn stone OR=3.07 [95%CI(1.78, 5.31)], hydronephrosis(moderatesevere) OR=1.57 [95%CI(1.02, 2.43)]. Conclusions Patients who were female, ≥60 years old, with diabetes mellitus, or preoperative infection history, larger stones(≥2 cm), staghorn stone or heavy renal hydroponectomy are more likely to have urosepsis after PCNL surgery.
引文
[1]Kim BS.Recent advancement or less invasive treatment of percutaneous nephrolithotomy[J].Korean J Urol,2015,56(9):614-623.
[2]邓月云,李秀宁.经皮肾镜碎石取石术后尿脓毒血症的相关因素[J].中国当代医药,2016(36):51-53.
[3]魏世平,李辉明,陶维雄,等.尿源性脓毒血症的临床诊疗[J].临床外科杂志,2014(11):864-865.
[4]冉光舜,罗江艳,胡洺瑀,等.经皮肾镜取石术后感染性休克37例临床分析[J].医学临床研究,2014,31(1):139-141.
[5]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.
[6]张世强.行经皮肾镜取石术的患者术后发生尿脓毒血症危险因素的分析[J].当代医药论丛,2017,15(2):90-91.
[7]张剑波.泌尿系统结石经皮肾镜手术后发生尿源性脓毒血症的影响因素[J].国际泌尿系统杂志,2016,36(2):187-190.
[8]张正龙,刘修恒,罗洪波,等.PCNL术后尿源性脓毒血症的危险因素及治疗研究[J].国际泌尿系统杂志,2017,37(2):206-209.
[9]李园.经皮肾镜取石术后并发感染性休克相关临床因素分析[J].基层医学论坛,2016,20(28):3947-3948.
[10]杨泽松,叶烈夫,胡敏雄,等.上尿路结石腔内碎石术后感染危险因素及建立术前预警评分系统的临床研究[J].中华泌尿外科杂志,2016,37(10):781-785.
[11]涂忠,刘昊,潘铁军.微通道经皮肾镜碎石术后感染性休克的危险因素分析[J].武汉大学学报(医学版),2013,34(4):581-584.
[12]肖建涛,黄凯,戴英波,等.mPCNL术后尿源性脓毒血症危险因素研究[J].中国感染控制杂志,2015,14(1):31-34.
[13]葛卫军,杨华伟,谢晓.PCNL术后并发尿脓毒血症的相关因素及防治分析[J].中国社区医师,2014,30(17):70-71.
[14]谢旭敏,潘铁军.经皮肾镜取石术后尿源性脓毒血症的危险因素分析[J].中华泌尿外科杂志,2015,36(1):50-53.
[15]陈光,罗建仕,何绍锋,等.探讨经皮肾镜术后并发感染性休克的危险因素[J].微创泌尿外科杂志,2015(04):242-244.
[16]陈书练.经皮肾镜取石术后尿源性脓毒症的危险因素分析[D].遵义医学院,2014.
[17]高子琨,张海滨,许文峰,等.PCNL术后脓毒血症并发休克危险因素分析[J].中外医学研究,2014,12(16):18-19.
[18]周炫辰,金讯波.经皮肾镜取石术后感染性休克的高危因素分析[J/CD].泌尿外科杂志(电子版),2012,4(1):29-32.
[19]Wang Y,Jiang F,Wang Y,et al.Post-percutaneous nephrolithotomy septic shock and severe hemorrhage:a study of risk factors[J].Urol Int,2012,88(3):307-310.
[20]Koras O,Bozkurt I H,Yonguc T,et al.Risk factors for postoperative infectious complications following percutaneous nephrolithotomy:a prospective clinical study[J].Urolithiasis,2015,43(1):55-60.
[21]Rashid AO,Fakhulddin SS.Risk factors for fever and sepsis after percutaneous nephrolithotomy[J].Asian J Urol,2016,3(2):82-87.
[22]Liu C,Zhang X,Liu Y,et al.Prevention and treatment of septic shock following mini-percutaneous nephrolithotomy:a single-center retrospective study of 834 cases[J].2013,31(6):1593-1597.
[23]Schr?der UC,Bokeloh F,O'Sullivan M,et al.Guidelines on urological infections[J].Biomicrofluidics,2015,13(6):361.
[24]Wagenlehner F,Tandogdu Z,Bartoletti R,et al.The global prevalence of infections in urology study:a long-term,worldwide surveillance study on urological infections[J].Pathogens,2016,5(1):10.
[25]王小瑞.糖尿病合并泌尿系感染患者临床特征及病原菌药敏试验分析[J].国际泌尿系统杂志,2015,35(4):565-568.
[26]胡辰,申吉泓.脓毒血症急性肾损伤的病理机制研究进展[J].国际泌尿系统杂志,2011,31(5):686-689.
[27]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.
[28]Miller NL,Evan AP,Lingeman JE.Pathogenesis of renal calculi[J].Urol Clin North Am,2007,34(3):295-313.
[29]陈斌.经皮肾镜碎石取石术后尿脓毒血症危险因素分析及防治进展[J].临床外科杂志,2017,25(2):96-99.
[2]邓月云,李秀宁.经皮肾镜碎石取石术后尿脓毒血症的相关因素[J].中国当代医药,2016(36):51-53.
[3]魏世平,李辉明,陶维雄,等.尿源性脓毒血症的临床诊疗[J].临床外科杂志,2014(11):864-865.
[4]冉光舜,罗江艳,胡洺瑀,等.经皮肾镜取石术后感染性休克37例临床分析[J].医学临床研究,2014,31(1):139-141.
[5]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.
[6]张世强.行经皮肾镜取石术的患者术后发生尿脓毒血症危险因素的分析[J].当代医药论丛,2017,15(2):90-91.
[7]张剑波.泌尿系统结石经皮肾镜手术后发生尿源性脓毒血症的影响因素[J].国际泌尿系统杂志,2016,36(2):187-190.
[8]张正龙,刘修恒,罗洪波,等.PCNL术后尿源性脓毒血症的危险因素及治疗研究[J].国际泌尿系统杂志,2017,37(2):206-209.
[9]李园.经皮肾镜取石术后并发感染性休克相关临床因素分析[J].基层医学论坛,2016,20(28):3947-3948.
[10]杨泽松,叶烈夫,胡敏雄,等.上尿路结石腔内碎石术后感染危险因素及建立术前预警评分系统的临床研究[J].中华泌尿外科杂志,2016,37(10):781-785.
[11]涂忠,刘昊,潘铁军.微通道经皮肾镜碎石术后感染性休克的危险因素分析[J].武汉大学学报(医学版),2013,34(4):581-584.
[12]肖建涛,黄凯,戴英波,等.mPCNL术后尿源性脓毒血症危险因素研究[J].中国感染控制杂志,2015,14(1):31-34.
[13]葛卫军,杨华伟,谢晓.PCNL术后并发尿脓毒血症的相关因素及防治分析[J].中国社区医师,2014,30(17):70-71.
[14]谢旭敏,潘铁军.经皮肾镜取石术后尿源性脓毒血症的危险因素分析[J].中华泌尿外科杂志,2015,36(1):50-53.
[15]陈光,罗建仕,何绍锋,等.探讨经皮肾镜术后并发感染性休克的危险因素[J].微创泌尿外科杂志,2015(04):242-244.
[16]陈书练.经皮肾镜取石术后尿源性脓毒症的危险因素分析[D].遵义医学院,2014.
[17]高子琨,张海滨,许文峰,等.PCNL术后脓毒血症并发休克危险因素分析[J].中外医学研究,2014,12(16):18-19.
[18]周炫辰,金讯波.经皮肾镜取石术后感染性休克的高危因素分析[J/CD].泌尿外科杂志(电子版),2012,4(1):29-32.
[19]Wang Y,Jiang F,Wang Y,et al.Post-percutaneous nephrolithotomy septic shock and severe hemorrhage:a study of risk factors[J].Urol Int,2012,88(3):307-310.
[20]Koras O,Bozkurt I H,Yonguc T,et al.Risk factors for postoperative infectious complications following percutaneous nephrolithotomy:a prospective clinical study[J].Urolithiasis,2015,43(1):55-60.
[21]Rashid AO,Fakhulddin SS.Risk factors for fever and sepsis after percutaneous nephrolithotomy[J].Asian J Urol,2016,3(2):82-87.
[22]Liu C,Zhang X,Liu Y,et al.Prevention and treatment of septic shock following mini-percutaneous nephrolithotomy:a single-center retrospective study of 834 cases[J].2013,31(6):1593-1597.
[23]Schr?der UC,Bokeloh F,O'Sullivan M,et al.Guidelines on urological infections[J].Biomicrofluidics,2015,13(6):361.
[24]Wagenlehner F,Tandogdu Z,Bartoletti R,et al.The global prevalence of infections in urology study:a long-term,worldwide surveillance study on urological infections[J].Pathogens,2016,5(1):10.
[25]王小瑞.糖尿病合并泌尿系感染患者临床特征及病原菌药敏试验分析[J].国际泌尿系统杂志,2015,35(4):565-568.
[26]胡辰,申吉泓.脓毒血症急性肾损伤的病理机制研究进展[J].国际泌尿系统杂志,2011,31(5):686-689.
[27]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.
[28]Miller NL,Evan AP,Lingeman JE.Pathogenesis of renal calculi[J].Urol Clin North Am,2007,34(3):295-313.
[29]陈斌.经皮肾镜碎石取石术后尿脓毒血症危险因素分析及防治进展[J].临床外科杂志,2017,25(2):96-99.