肾盂尿及结石细菌培养与经皮肾镜取石术后尿脓毒症的相关性研究

赵蓉; 沈昊; 周家杰; 常洁; 陈诗幻

doi:10.13201/j.issn.1001-1420.2019.07.014

肾盂尿及结石细菌培养与经皮肾镜取石术后尿脓毒症的相关性研究

- 1. 荆州市中心医院泌尿外科(湖北荆州, 434020);
- 2. 武汉大学人民医院泌尿外科
基金项目:
荆州市科技局项目（编号2016082）

详细信息

通讯作者: 周家杰,E-mail:2009203020115@whu.edu.cn

中图分类号: R691.3

收稿日期: 2018-10-16

Correlation between bacteria culture of renal pelvis urine, bacteria culture of calculi and urosepsis after percutaneous nephrolithotomy

- 1. Department of Urology, Jingzhou Central Hospital, Jingzhou, Hubei, 434020, China;
- 2. Department of Urology, Renmin Hospital of Wuhan University

More Information

Corresponding author: ZHOU Jiajie, E-mail: 2009203020115@whu.edu.cn

Received Date: 16 October 2018

摘要

摘要: 目的：探讨肾盂尿及结石细菌培养与经皮肾镜取石术（PCNL）后尿脓毒症的相关性。方法：收集2016年10月~2018年10月在我院接受PCNL治疗、符合纳入及排除标准的220例上尿路结石患者。所有患者留取术前中段尿、术中肾盂尿、结石标本做细菌培养，统计患者年龄、性别、结石大小、肾积水程度等临床资料；术后监测患者体温、心率、呼吸及血常规等与脓毒症相关的指标；分析中段尿、肾盂尿和结石细菌培养结果之间的关系，使用单因素和多因素的统计方法分析各危险因素与PCNL后发生尿脓毒症的关系。结果：肾盂尿与结石培养结果之间具有很高的相关性，但二者分别与中段尿的培养结果之间无明显相关性；中段尿细菌培养、年龄、性别、肾积水程度、清石率与PCNL后尿脓毒症的发生无明显相关性，术中肾盂尿细菌培养阳性、结石细菌培养阳性、较大体积的结石、较长的手术时间与术后尿脓毒症的发生密切相关，并且肾盂尿培养阳性和结石培养阳性是术后发生尿脓毒症的独立危险因素。结论：术中肾盂尿及结石细菌培养与术前中段尿细菌培养相比，对术后尿脓毒症的相关性更高，在PCNL术中应常规进行肾盂尿及结石细菌培养及药敏试验。
- 肾盂尿 /
- 结石 /
- 细菌培养 /
- 尿脓毒症 /
- 经皮肾镜取石术
Abstract: Objective: To discuss the correlation between bacteria culture of renal pelvis urine, bacteria culture of calculi and urosepsis after percutaneous nephrolithotomy (PCNL).Method: From October 2016 to October2018, 220 patients with upper urinary tract calculi who matched the inclusion and exclusion standard and decided to be treated with PCNL in our department were included.All the patients took preoperative midstream urine, renal pelvis urine and stones for bacterial culture, and their clinical data like age, sex, stone size and degree of hydronephrosis were collected.The postoperative condition like blood routine, body temperature, heart rate and respiration would be monitored to evaluate the postoperative complications like sepsis.The relationship between the results of midstream urine, renal pelvis and calculi bacteria culture were analyzed, univariate and multivariate statistical methods were used to analyze the relationship between risk factors and urosepsis after PCNL.Result: There was a high correlation between the bacteria culture of renal pelvis urine and calculi culture, however, there was no significant correlation between renal pelvis urine and midstream urine, and there was no significant correlation between calculi and midstream urine.There was no statistically significant difference between the occurrence of urosepsis after PCNL and midstream urine culture, age, gender, degree of renal hydronephrosis and stone clearance.Positive culture of bacteria of renal pelvis and calculi during operation, larger volume of calculi, longer operation time were closely related to the occurrence of urosepsis after PCNL.In addition, positive culture of renal pelvis urine and calculi were independent risk factors for postoperative urosepsis.Conclusion: Compared with the culture of middle urinary bacteria, the positive culture of renal pelvis urine and calculi may result in higher incidence of postoperative urosepsis.In PCNL, the bacterial culture and drug susceptibility test of calculi and renal pelvis urine should be performed routinely.
- renal pelvis urine /
- calculi /
- bacterial culture /
- urosepsis /
- percutaneous nephrolithotomy

HTML全文

参考文献(21)

[1]	叶章群, 周辉.泌尿系结石基础研究及临床新进展[J].中华泌尿外科杂志, 2017, 38 (9):644-649.
[2]	那彦群, 叶章群, 孙颖浩, 等.中国泌尿外科疾病诊断治疗指南[M].北京:人民卫生出版社, 2014:715-732.
[3]	Kreydin E I, Eisner B H.Risk factors for sepsis after percutaneous renal stone surgery[J].Nat Rev Urol, 2013, 10 (10):598-605.
[4]	那彦群, 叶章群, 孙颖浩, 等.中国泌尿外科疾病诊断治疗指南[M].北京:人民卫生出版社, 2014:428-429.
[5]	Hasan S D, Fuad G, Yesim S, et al.Importance of microbiological evaluation in management of infectious complications following pecutaneous nephrolithotomy[J].Int Urol Nephrol, 2007, 39 (2):737-742.
[6]	石鑫, 李炯明, 刘建和, 等.经皮肾镜取石术并发感染性休克的原因和防治进展[J].中华泌尿外科杂志, 2014, 35 (11):873-875.
[7]	Benson A D, Juliano T M, MilIer N L.Infectious outcomes in nephrostomy drainage before percutaneous nephrolithotomy compared to concurrent access[J].JUrol, 2014, 192:770-774.
[8]	刘相德.脓毒症和感染性休克治疗进展[J].创伤与急危重病医学, 2014, 2 (1):14-17.
[9]	李天, 李逊, 何永忠, 等.微创经皮肾镜取石术后并发感染性休克的诊治体会[J].临床泌尿外科杂志, 2012, 27 (3):182-187.
[10]	那彦群, 叶章群, 孙颖浩, 等.中国泌尿外科疾病诊断治疗指南[M].北京:人民卫生出版社, 2014:152.
[11]	Nemoy N J, Staney T A.Surgical, bacteriological and biochemical management of "infection stones"[J].JA-MA, 1971, 215 (9):1470-1476.
[12]	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.
[13]	Lewis S, Patel U.Major complications after percutaneous nephrostomy-lessons from a department audit[J].Clin Radiol, 2004, 59 (2):171-179.
[14]	Chen L, Xu Q Q, Li J X, et al.Systemic inflammatory response syndrome after percutaneous nephrolithotomy:an assessment of risk factors[J].Int J Urol, 2008, 15 (12):1025-1028.
[15]	Jan H, Akbar I, Kamran H, et al.Frequency of renal stone disease in patients with urinary tract infection[J].J Ayub Med Col Abbottabad, 2008, 20 (1):60-62.
[16]	Mariappan P, Smith G, Moussa S A, et al.One week of ciprofloxacin before percutaneous nephrolithotomy significantly reduces upper tract infection and urosepsis:a prospective controlled study[J].BJU international, 2006, 98 (5):1075-1079.
[17]	吴文起, 肖成林, 梁叶萍, 等.上尿路结石细菌培养的临床意义[J].现代泌尿外科杂志, 2013, 18 (1):19-22.
[18]	Margel D, Ehrlich Y, Brown N, et al.Clinical implication of routine stone culture in percutaneous nephrolithotomy-aprospective study[J].Urology, 2006, 67 (1):26-29.
[19]	Lojanapiwat B, Kitirattrakarn P.Role of preoperative and intraoperative factors in mediating infection complication followingpercutaneous nephrolithotomy[J].Urol Int, 2011, 86 (4):448-452.
[20]	熊海云, 曾小明, 余明主, 等, 经皮肾镜取石术前尿培养与术后全身炎症反应综合征的关系[J].临床泌尿外科杂志, 2014, 29 (2):106-107, 112.
[21]	Kreydin E I, Eisner B H.Risk factors for sepsis after percutaneous renal stone surgery[J].Nat Rev Urol, 2013, 10 (10):598-605.