The valuable experience of septic shock following minimally invasive percutaneous nephrolithotomy
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摘要: 目的:探讨微创经皮肾镜取石术后并发感染性休克的发生原因及防治。方法:回顾性分析2007年5月~2011年4月11例患者行微创经皮肾镜取石术后并发感染性休克临床资料。出现休克后首要措施为补足血容量和控制感染,监测中心静脉压。血管活性药物在充分扩容的基础上使用,大剂量皮质激素和碱性药物的应用也极为重要。结果:11例患者均在6~36 h后逐渐停用升压药物,3天后体温及血常规恢复正常。待血或中段尿细菌培养阴性后出院。结论:微创经皮肾镜取石术后发生感染性休克原因多为术前未能有效控制尿路感染、手术时间过长、术中肾盂压力过高、术后引流不畅等。术前充分准备和有效抗感染及术中提高碎石技巧和低压灌注、分期手术等是减少感染性休克发生的有效途径。成功救治的关键在于对感染性休克的早期诊断及处理。Abstract: Objective:To investigate the the etiology and treatment of septic shock following minimally invasive percutaneous nephrolithotomy.Method:Retrospective analysis:11 cases of septic shock following minimally invasive percutaneous nephrolithotomy from May 2007 to April 2011. The first important measure was supplying volume of blood and controlling infections.it would be better to treat septic shock under the central venous pressure catheter.Vasodilatation drug should be using under the sufficient expansion, moreover the usage of large dose of cortical hormone and alkaline drug was vers important too.Result:11 cases taper off using the drug,which couid rise the blood pressure,meanwhile the animal heat and routine analysis of blood become normal in 3 days. The patients couid discharge from hospital when the mid-stream urine culture indicates negative.Conclusion:The therapy of septic shock following minimally invasive percutaneous nephrolithotomy, the general causes should be that the urinary tract infections couid not be controlled availably before operation, long time of operation, hyperpiesia of renal intrapelvic pressure during the procesure, inadequate drainage after operation, ect. The best way to reduce to the occurence of septic shock was enough preparation before operation,effective anti-infection, improving the skill of lithotripsy, fluid infusion under hypopiesia and staging operation. The successful keys lie in the early diagnosing and timely treating for septic shock.
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[1] 那彦群,孙光主编.中国泌尿外科疾病诊断治疗指南[M].北京:人民卫生出版社,2009:236-238.
[2] 吴在德,吴肇汉主编.外科学[M].第7版.北京:人民卫生出版社,2008:43-45.
[3] 高旭,许传亮,陈策,等.输尿管镜下钬激光碎石术后重症感染诊治体会[J].中华泌尿外科杂志,2005,26:33-35.
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