Risk factors analysis of systemic inflammatory response syndrome following percutaneous nephrolithotomy
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摘要: 目的:探讨经皮肾镜取石术(percutaneous nephrolithotomy, PCNL)术后发生全身炎症反应综合征(systemic inflammatory response syndrome, SIRS)的危险因素。方法:回顾性分析114例一期行PCNL术的肾结石患者的临床资料,根据患者术后是否发生SIRS分为两组,通过logistic回归分析评价各因素与术后发生SIRS的相关性。结果:114例患者成功接受一期PCNL手术,其中21例(18.4%)术后发生SIRS。与非SIRS组比较,SIRS组的术前尿常规白细胞、亚硝酸盐及尿培养结果阳性率高,且铸型结石的比例更高,差异均有统计学意义(P<0.05),而非SIRS组患者一期结石清除率为76.3%(71/93),SIRS组患者一期结石清除率为52.4%(11/21),差异有统计学意义(P<0.05)。多因素回归分析显示术前尿常规白细胞阳性、铸型结石是PCNL术后发生SIRS的相关危险因素(P<0.05)。结论:术前尿常规白细胞阳性及铸型结石是PCNL术后发生SIRS的危险因素。Abstract: Objective: To evaluate the risk factors of systemic inflammatory response syndrome(SIRS) after percutaneous nephrolithotomy(PCNL).Methods: A retrospective analysis was performed on 114 renal stone patients who underwent PCNL. The patients were divided into two groups according to the occurrence of SIRS after PCNL. Logistic regression analysis was used to screen the risk factors of SIRS after PCNL.Results: All 114 patients successfully underwent PCNL, and 21 patients(18.4%) developed SIRS. Compared with the non-SIRS group, the preoperative positive urinary leukocytes, nitrite and urine culture results in the SIRS group were higher, as well as the cast mould stone, with statistically significant difference(P<0.05). The first-stage stone clearance in the non-SIRS group was 76.3%(71/93), while in the SIRS group was 52.4(11/21), with statistically significant difference(P<0.05). Multivariate regression analysis showed that preoperative positive urinary leukocytes and cast mould stone were the risk factors for SIRS after PCNL(P<0.05).Conclusion: Preoperative positive urinary leukocytes and cast mould stone were the risk factors for SIRS after PCNL.
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[1] Ganpule AP,Vijayakumar M,Malpani A,et al.Percutaneous nephrolithotomy(PCNL)a critical review[J].Int J Surg,2016,36(Pt D):660-664.
[2] Jessen JP,Honeck P,Knoll T,et al.Percutaneous nephrolithotomy under combined sonographic/radiologic guided puncture:results of a learning curve using the modified Clavien grading system[J].World J Urol,2013,31(6):1599-1603.
[3] Yang T,Liu S,Hu J,et al.The Evaluation of Risk Factors for Postoperative Infectious Complications after Percutaneous Nephrolithotomy[J].Biomed Res Int,2017,2017:4832051.
[4] Scales CD Jr,Smith AC,Hanley JM,et al.Prevalence of kidney stones in the United States[J].Eur Urol,2012,62(1):160-165.
[5] de la Rosette J,Assimos D,Desai M,et al.The Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study:indications,complications,and outcomes in 5803 patients[J].J Endourol,2011,25(1):11-17.
[6] Ramaraju K,Paranjothi AK,Namperumalsamy DB,et al.Predictors of systemic inflammatory response syndrome following percutaneous nephrolithotomy[J].Urol Ann,2016,8(4):449-453.
[7] 刘余庆,卢剑,郝一昌,等.微创经皮肾镜取石术后发生全身炎症反应综合征的多因素分析[J].中国微创外科杂志,2018,18(1):1-5.
[8] 艾来提·吾甫尔,哈木拉提·吐送,安尼瓦尔·牙生.经皮肾镜碎石术后并发全身炎症反应综合征的危险因素分析及预测模型的建立[J].微创泌尿外科杂志,2019,8(1):40-45.
[9] Ganesan V,Brown RD,Jiménez JA,et al.C-Reactive Protein and Erythrocyte Sedimentation Rate Predict Systemic Inflammatory Response Syndrome After Percutaneous Nephrolithotomy[J].J Endourol,2017,31(7):638-644.
[10] Xu H,Hu L,Wei X,et al.The Predictive Value of Preoperative High-Sensitive C-Reactive Protein/Albumin Ratio in Systemic Inflammatory Response Syndrome After Percutaneous Nephrolithotomy[J].J Endourol,2019,33(1):1-8.
[11] Sen V,Bozkurt IH,Aydogdu O,et al.Significance of preoperative neutrophil-lymphocyte count ratio on predicting postoperative sepsis after percutaneous nephrolithotomy[J].Kaohsiung J Med Sci,2016,32(10):507-513.
[12] 李东升,杨彦峰,李亚飞,等.经皮肾镜取石术后全身炎症反应综合征的危险因素分析[J].临床泌尿外科杂志,2015,30(04):335-338,341.
[13] Gonzalez-Ramirez A,Camarena L,Gutierrez-Aceves J.1544 risk factors for fever and sepsis after percutaneous nephrolithotomy[J].J Urol,2013,189(4):633-633.
[14] Liu J,Zhou C,Gao W,et al.Does preoperative urine culture still play a role in predicting post-PCNL SIRS?A retrospective cohort study[J].Urolithiasis,2020,48(3):251-256.
[15] Hatt JK,Rather PN.Role of bacterial biofilms in urinary tract infections[J].Curr Top Microbiol Immunol,2008,322:163-192.
[16] Mariappan P,Tolley DA.Endoscopic stone surgery:minimizing the risk of post-operative sepsis[J].Curr Opin Urol,2005,15(2):101-105.
[17] Tuerk C,Petrik A,Scrica K,et al.EAU Guidelines on Diagnosis and Conservative Management of Urolithiasis[J].Eur Urol,2016,69(3):468-474.
[18] Kreydin EI,Eisner BH.Risk factors for sepsis after percutaneous renal stone surgery[J].Nat Rev Urol,2013,10(10):598-605.
[19] 尿路感染诊断与治疗中国专家共识编写组.尿路感染诊断与治疗中国专家共识(2015版)——复杂性尿路感染[J].中华泌尿外科杂志,2015,36(4):241-244.
[20] 卞崔冬,黄盛松,廖国强,等.降钙素原监测对上尿路结石术后感染性休克早期诊治的价值[J].外科研究与新技术,2015,4(3):145-148.
[21] Zheng J,Li Q,Fu W,et al.Procalcitonin as an early diagnostic and monitoring tool in urosepsis following percutaneous nephrolithotomy[J].Urolithiasis,2015,43(1):41-47.
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