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目的:筛选上尿路结石患者行经皮肾镜取石术(PCNL)后发生全身炎症反应综合征(SIRS)的危险因素,为预防、治疗术后感染提供依据。方法:回顾性分析2010年10月~2014年5月我院收治的上尿路结石并接受PCNL的852例患者的临床资料,运用单因素四格表χ2检验及多因素非条件二分类Logistic回归分析的统计学方法,筛选术后发生SIRS的危险因素,制定围手术期预防及护理措施。结果:852例手术患者术后发生SIRS 284例,感染率为33.33%,其中感染性休克8例占0.94%;经四格表χ2检验,年龄、糖尿病、术前尿路感染、术前患肾积水、术前血肌酐、结石数量、结石最大径、结石部位、腔内操作时间、结石残留等10个变量与术后SIRS发生相关(P<0.05);经非条件二分类Logistic回归分析,糖尿病、术前尿路感染、术前患肾积水、术前血肌酐、结石数量、结石最大径、腔内操作时间等7个因素是术后SIRS的相关危险因素(P<0.05)。结论:分析待术患者相关危险因素,术前积极控制血糖、预防性应用抗菌药物严格控制术前感染、术中尽量缩短腔内操作时间是降低PCNL术后SIRS发生率的重要措施。
Objective: To screen the risk factors of systemic inflammatory response syndrome (SIRS) after percutaneous nephrolithotomy (PCNL) in patients with upper urinary tract calculi and to provide basis for prevention and treatment of postoperative infection. Methods: The clinical data of 852 patients with upper urinary tract stones admitted to our hospital from October 2010 to May 2014 in our hospital were retrospectively analyzed. One-factor four-table χ2 test and multivariate non-conditional logistic regression Analysis of statistical methods, screening for the occurrence of SIRS risk factors, the development of perioperative prevention and care measures. Results: A total of 284 cases of SIRS were found in 852 cases of surgery. The infection rate was 33.33%, of which 8 cases were septic shock (0.94%). The chi square test, age, diabetes mellitus, preoperative urinary tract infection, (P <0.05); There was no significant difference between the two groups (P> 0.05). Logistic regression analysis showed that 10 variables of hydrocephalus, preoperative serum creatinine, number of calculus, maximum diameter of calculus, location of calculus, intraluminal operation time and residual calculus were correlated with postoperative SIRS Preoperative urinary tract infection, preoperative hydronephrosis, preoperative serum creatinine, the number of stones, the largest diameter of stones, intraluminal operation time were the risk factors for postoperative SIRS (P <0.05). Conclusion: It is an important measure to reduce the incidence of postoperative SIRS in patients undergoing PCNL by analyzing the relevant risk factors in patients undergoing surgery, positively controlling blood glucose before operation, and prophylactically applying antibiotics to strictly control the preoperative infection.