微通道经皮肾镜取石术感染性休克危险因素分析

Risk factors of septic shock after mini-percutaneous nephrolithotripsy*

摘要:

目的 探讨微通道经皮肾镜取石术（mPCNL）发生感染性休克的危险因素。方法 对2013年1月-2014年12月该科经治的1 590例mPCNL患者的临床资料进行回顾性分析，采用单因素χ2检验和Logistic回归分析法分析mPCNL术后发生感染性休克的危险因素。结果 术后18例患者发生感染性休克，其中男6例，女12例，年龄28～69岁，平均（45.6±13.5）岁，术前尿常规白细胞（WBC）阳性率100.00%，结石直径1.5～5.0 cm，单通道取石15例，多通道3例，手术时间45～200 min，平均（87.0±56.0）min，18例患者中2例因继发多器官功能衰竭而死亡，余好转出院。χ2分析结果显示女性、术前尿常规WBC（+++～++++）、术前未行肾造瘘与感染性休克的发生相关，Logistic回归分析显示女性、术前未行肾造瘘与感染性休克的发生相关。结论 女性、术前未行肾造瘘是mPCNL术后发生感染性休克的危险因素。

Abstract:

Objective To evaluate the risk factors of septic shock after mini-percutaneous nephrolithotripsy (mPCNL). Methods Clinical data of 1 590 cases who underwent mPCNL from January 2013 to December 2014 were retrospectively analyzed. The χ2 test and logistic regression were used to identify the key risk factors for septic shock after mPCNL. Results Of the 1 590 patients, 18 patients suffered septic shock, including 6 male patients and 12 female patients. Their mean age was (45.6 ± 13.5) years (28 ～ 69 years). White cell in urine was 100 percent, the stone diameter ranged from 1.5 to 5.0 cm, unichannel for 15 cases while multichannel for 3 cases, the operation duration ranged from 45 to 200 min, mean (87.0 ± 56.0) min. 2 in 18 cases died in multiple organ failure, the others recovered till discharged. In χ2 test, female gender (P = 0.001), (+++ ～ ++++) white cells in urine (P = 0.042), un-preoperative nephrostomy drainage (P = 0.041) had significant association with septic shock after mPCNL. While in multivariate analysis, female gender (■ = 5.471, 95 % CI: 0.756～21.452, P < 0.05) and un-preoperative nephrostomy drainage (■ = 3.106, 95 % CI: 1.283～7.907, P < 0.05) were identified as independent risk factors for septic shock after mPCNL. Conclusions Female gender and un-preoperative nephrostomy drainage are the key risk factors for septic shock after mPCNL.