Zhu Likun, Jiang Rui, Pei Lijun, Li Xu, Kong Xiangjun, Wang Xinwei
Department of Urology Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China.
Nephropathy Clinical Medical Research Center of Sichuan Province, Luzhou 646000, China.
Transl Androl Urol. 2020 Jun;9(3):1262-1269. doi: 10.21037/tau.2020.03.37.
It's very common to see the onset of fever after percutaneous nephrolithotomy (PCNL), it's necessary to analyze the risk factors for the fever following PCNL, and to provide evidence for infection prevention after PCNL.
A total of 546 adult PCNL patients were included as study subjects and retrospective studies were performed. We collected clinical data of patients using a prospectively designed database. Univariate and multivariate logistic regression analyses were performed to identify the potential risk factors for the fever after PCNL.
Of the included 546 PCNL patients, there were 82 fever patients and 464 no-fever patients following PCNL. Escherichia coli and Proteus mirabilis are the two most common infectious bacteria. Preoperative urinary tract infection (OR =4.38, 95% CI: 1.15-9.53), multiple access (OR =5.31, 95% CI: 1.23-10.75), diabetes (OR =4.97, 95% CI: 1.37-9.86), length of operation ≥60 min (OR =5.67, 95% CI: 2.24-13.42), estimated blood loss in PCNL ≥500 mL (OR=2.78, 95% CI: 2.32-3.61) were the independent risk factors associated with postoperative infection.
Effective control of urinary tract infection, reduction of access number, strict control of blood glucose, length of operation control, reduction of intraoperative bleeding should be considered as measures to prevent postoperative fever for patients with PCNL.
经皮肾镜取石术(PCNL)后发热很常见,有必要分析PCNL后发热的危险因素,为PCNL术后预防感染提供依据。
共纳入546例成年PCNL患者作为研究对象,进行回顾性研究。我们使用前瞻性设计的数据库收集患者的临床资料。进行单因素和多因素逻辑回归分析,以确定PCNL后发热的潜在危险因素。
在纳入的546例PCNL患者中,PCNL术后有82例发热患者和464例未发热患者。大肠埃希菌和奇异变形杆菌是两种最常见的感染细菌。术前尿路感染(OR = 4.38,95%CI:1.15 - 9.53)、多通道(OR = 5.31,95%CI:1.23 - 10.75)、糖尿病(OR = 4.97,95%CI:1.37 - 9.86)、手术时间≥60分钟(OR = 5.67,95%CI:2.24 - 13.42)、PCNL术中估计失血量≥500 mL(OR = 2.78,95%CI:2.32 - 3.61)是与术后感染相关的独立危险因素。
对于PCNL患者,应将有效控制尿路感染、减少通道数量、严格控制血糖、控制手术时间、减少术中出血作为预防术后发热的措施。