论文部分内容阅读
目的:探讨输尿管软镜钬激光碎石术(FUL)术后发生全身炎症反应综合征(SIRS)的风险因素。方法:分析2012年10月~2014年11月间260例患者临床资料,按术后是否发生SIRS分组,单因素分析比较年龄、性别、BMI、结石大小、尿路感染、肾积水、灌注、输尿管通道鞘、手术时间、结石成分等风险因素,随后通过多因素逻辑回归分析,计算Odds比值(OR)和95%可信区间(95%CI)以确定FUL术后SIRS的独立风险因素。结果:FUL术后SIRS发生率8.1%(21/260)。在单因素分析中,SIRS与患者性别(P<0.01)、结石大小(P=0.001)、灌注速度(P<0.01)及灌注量(P<0.01)有显著相关性。多因素逻辑回归分析确定结石大小(OR=1.691,95%CI:0.879~3.255)、小口径输尿管通道鞘(OR=2.293,95%CI:0.730~7.200)、灌注速度(OR=1.161,95%CI:1.096~1.230)及感染性结石(OR=3.331,95%CI:0.971~11.426)为FUL术后SIRS的独立风险因素。结论:结石大负荷、感染性结石是FUL术后SIRS危险因素,具有这些危险因素的患者FUL时应控制手术时间,必要时分期手术;FUL术中宜使用低压低流灌注,并使用大口径输尿管通道鞘提供引流,用以降低FUL术中肾盂内压。
Objective: To investigate the risk factors of systemic inflammatory response syndrome (SIRS) after ureteroscopic holmium laser lithotripsy (FUL). Methods: The clinical data of 260 patients from October 2012 to November 2014 were analyzed retrospectively. According to the SIRS grouping after operation, the single factor analysis was used to compare the age, sex, BMI, stone size, urinary tract infection, hydronephrosis, Ureteral duct sheath, operation time and calculus composition were analyzed. Odds ratio (OR) and 95% confidence interval (95% CI) were calculated by multivariate logistic regression to determine the independent risk factors of SIRS after FUL. Results: The incidence of SIRS after FUL was 8.1% (21/260). In univariate analysis, there was a significant correlation between SIRS and patient’s gender (P <0.01), stone size (P = 0.001), perfusion speed (P <0.01) and perfusion volume (P <0.01) Multivariate logistic regression analysis was used to determine the stone size (OR = 1.691, 95% CI 0.879-3.255), small diameter ureteral access sheath (OR = 2.293, 95% CI 0.730-7.200) CI: 1.096 ~ 1.230) and infectious stones (OR = 3.331,95% CI: 0.971 ~ 11.426) were independent risk factors for SIRS after FUL. Conclusions: Large load of stones and infective stones are the risk factors of SIRS after FUL. Patients with these risk factors should control the operation time when FUL and staged surgery if necessary. Low-pressure and low-flow perfusion should be used in FUL and large-caliber ureter Channel sheath provides drainage to reduce renal pelvis pressure in FUL.