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目的:探讨上尿路腔内碎石术后并发感染性休克的原因和防治措施。方法:回顾性分析2005年1月～2008年3月上尿路腔内碎石术后6例感染性休克患者的临床资料:男4例,女2例,年龄38～61岁,平均47岁。其中经皮肾镜(PCNL)治疗者4例,经尿道输尿管镜治疗者2例,均表现为术后3～16 h内出现高热(体温>39.0℃),血压降至80/50 mmHg(1 mmHg=0.133 kPa)以下,心率>110次/min。根据临床表现均诊断为感染性休克。6例均给予抗休克和抗感染等治疗。结果:5例患者在10～52 h后逐渐停用升压药物,1周内体温和血常规恢复正常,最后治愈出院。1例因出现多脏器功能障碍综合征(MODS)而于术后第6天抢救无效死亡。结论:感染性休克是上尿路腔内碎石术后严重并发症之一,早期发现及合理处理是治疗成功的关键,加强预防措施可减少术后重症感染。
Objective: To investigate the causes and prevention measures of septic shock caused by upper urinary tract lithotripsy. Methods: The clinical data of 6 patients with septic shock after upper urinary tract lithotripsy from January 2005 to March 2008 were retrospectively analyzed: 4 males and 2 females, aged from 38 to 61 years, with an average of 47 years . Among them, 4 cases were treated by PCNL and 2 cases were treated by transurethral ureteroscopy. All of them showed high fever (body temperature> 39.0 ℃) within 3 to 16 hours after operation and blood pressure dropped to 80/50 mmHg mmHg = 0.133 kPa), heart rate> 110 beats / min. According to clinical manifestations were diagnosed as septic shock. 6 cases were given anti-shock and anti-infection treatment. Results: In 5 patients, vasopressor was gradually stopped after 10 ~ 52 h, body temperature and blood routine returned to normal within 1 week, finally cured and discharged. 1 case died of multiple organ dysfunction syndrome (MODS) and died on the 6th day after the operation. Conclusion: Septic shock is one of the serious complications of upper urinary tract lithotripsy. Early detection and rational treatment are the keys to successful treatment. Strengthening preventive measures can reduce severe postoperative infection.