He Z, Tang F, Lei H, Chen Y, Zeng G
Department of urology, Minmally Invasive Surgery Center, Guangdong Provincial Key Laboratory of Urology, the First Affiliated Hospital of Guangzhou Medical University, 510230 Guangzhou, China.
Department of urology, Minmally Invasive Surgery Center, Guangdong Provincial Key Laboratory of Urology, the First Affiliated Hospital of Guangzhou Medical University, 510230 Guangzhou, China.
Prog Urol. 2018 Oct;28(12):582-587. doi: 10.1016/j.purol.2018.06.006. Epub 2018 Jul 7.
To explore the risk factors for systemic inflammatory response syndrome (SIRS) after percutaneous nephrolithotomy (PCNL).
A retrospective chart review was performed to identify 1030 patients who had undergone PCNL from January 2014 to July 2016 in the Minimally Invasive Surgery Center. Multiple data, including age, sex, body mass index (BMI), operation time, Staghorn calculi, diabetes, Serun creatinine, preoperative urine culture and the urinary sediment microscopy white blood cell (WBC) were collected. These factors and postoperative SIRS were retrospectively analyzed.
There were 108 cases (10.49%) of SIRS among 1030 patients. The results of univariate analysis showed that sex (P=0.015), Staghorn calculi (P<0.001), preoperative urinary culture of Gram-negative bacteria (P<0.001) and preoperative urinary sediment microscopy WBC (+, ++, +++, ++++) (P<0.001, P<0.001, P=0.009, P=0.045) were correlated with postoperative SIRS (P<0.05). According to Multivariate analysis results, the likelihood of SIRS after PCNL increased with Staghorn calculi (P=0.01, OR=10.457, 95% CI=1.312-3.092), the urinary sediment microscopy WBC (+∼++++) (P<0.001, OR=2.591, 95% CI=1.661-4.042) and positive urine culture for Gram-negative bacteria (P<0.001, OR=3.550, 95% CI=2.205-5.715).
Staghorn calculi, the urinary sediment microscopy WBC and positive urine culture for Gram-negative bacteria are independent risk factors for SIRS. Patients affected by these risk factors should receive careful anti-infectious perioperative management for prevention of postoperative SIRS.
探讨经皮肾镜取石术（PCNL）后发生全身炎症反应综合征（SIRS）的危险因素。
进行一项回顾性病历审查，以确定2014年1月至2016年7月在微创外科中心接受PCNL的1030例患者。收集了多项数据，包括年龄、性别、体重指数（BMI）、手术时间、鹿角形结石、糖尿病、血清肌酐、术前尿培养及尿沉渣显微镜检查白细胞（WBC）。对这些因素与术后SIRS进行回顾性分析。
1030例患者中有108例（10.49%）发生SIRS。单因素分析结果显示，性别（P=0.015）、鹿角形结石（P<0.001）、术前革兰阴性菌尿培养（P<0.001）及术前尿沉渣显微镜检查白细胞（+、++、+++、++++）（P<0.001、P<0.001、P=0.009、P=0.045）与术后SIRS相关（P<0.05）。根据多因素分析结果，PCNL后发生SIRS的可能性随鹿角形结石（P=0.01，OR=10.457，95%CI=1.312 - 3.092）、尿沉渣显微镜检查白细胞（+～++++）（P<0.001，OR=2.591，95%CI=1.661 - 4.042）及革兰阴性菌尿培养阳性（P<0.001，OR=3.550，95%CI=2.205 - 5.715）而增加。
鹿角形结石、尿沉渣显微镜检查白细胞及革兰阴性菌尿培养阳性是SIRS的独立危险因素。受这些危险因素影响的患者应在围手术期接受仔细的抗感染管理，以预防术后SIRS。
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