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目的探讨上尿路结石经皮肾镜术后全身炎症反应综合征(systemic inflammatory response syndrome,SIRS)的危险因素。方法回顾本院泌尿外科2012年5月-2015年9月267例经皮肾镜碎石术后患者的临床资料,通过单因素及多因素Logistic回归分析全身炎症反应综合征的危险因素。结果 267例中,41例(15.4%)出现SIRS表现。其中4例病情加重发生感染性休克,经积极抗感染、对症支持治疗后均恢复,无死亡病例。单因素分析结果表明反复尿路感染病史、手术时间、结石负荷、鹿角形结石与术后SIRS的发生具有相关性。多因素分析发现术前反复尿路感染病史(OR=6.759,P<0.01)、鹿角形结石(OR=6.501,P<0.01)是经皮肾镜术后并发SIRS的独立危险因素。结论对于具有反复尿路感染病史以及鹿角形结石的患者要提高警惕,术前积极控制感染,术中注意无菌操作、避免集合系统损伤,术后严密监控,以降低SIRS发生率。
Objective To investigate the risk factors of systemic inflammatory response syndrome (SIRS) after percutaneous nephrolithotomy in upper urinary tract calculi. Methods The clinical data of 267 patients who underwent percutaneous nephrolithotomy were retrospectively analyzed from May 2012 to September 2015 in our hospital. The risk factors of systemic inflammatory response syndrome were analyzed by single factor and multivariate logistic regression. Results Among 267 cases, 41 cases (15.4%) showed SIRS. Four of them exacerbated septic shock. After active anti-infective and symptomatic supportive treatment, they all recovered without any deaths. Univariate analysis showed that the history of recurrent urinary tract infection, operative time, stone load, antler stone correlated with the incidence of postoperative SIRS. Multivariate analysis revealed a history of recurrent urinary tract infections (OR = 6.759, P <0.01). Antagonistic staghorn stones (OR = 6.501, P <0.01) were independent risk factors for SIRS after percutaneous nephrolithotomy. Conclusions Patients with recurrent urinary tract infections and antler stones should be vigilant. Active infection should be controlled preoperatively. During the operation, aseptic technique should be taken to avoid the damage of the collection system and be monitored closely to reduce the incidence of SIRS.