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目的:分析经皮肾镜钬激光碎石术治疗泌尿系结石术后急性肾损伤(AKI)发生的高危因素。方法:回顾性分析上海长海医院泌尿外科2012年8月~2014年2月间行经皮肾镜钬激光碎石术治疗的泌尿系结石患者的临床资料,根据患者术后血肌酐升高程度,分为AKI组和非AKI组,采用单因素和多因素Logistic回归分析经皮肾镜钬激光碎石术后AKI发生的高危因素。结果:共纳入405例经皮肾镜钬激光碎石术患者,27例术后出现AKI,发生率为6.7%(27/405)。单因素分析显示,AKI组平均年龄高于非AKI组[(54.63±8.97)岁vs.(49.03±12.29)岁,P=0.021];AKI组糖尿病比例高于非AKI组(18.5%vs.6.1%,P=0.014);AKI组孤立肾比例高于非AKI组(18.5%vs.3.7%,P=0.002)。进一步的多因素分析显示糖尿病(OR=5.409)、孤立肾(OR=6.997)和术前eGFR<60ml·min-1·1.73m~(-2)(OR=2.649)是经皮肾镜钬激光碎石术后急性肾损伤的独立危险因素。结论:糖尿病、孤立肾和eGFR降低(<60 ml·min~(-1)·1.73 m~(-2))是经皮肾镜钬激光碎石术后AKI发生的独立危险因素。
Objective: To analyze the risk factors of percutaneous nephroscope holmium laser lithotripsy in the treatment of acute kidney injury (AKI) after urolithiasis. Methods: The clinical data of urolithiasis treated by percutaneous nephroscope holmium laser lithotripsy in Department of Urology, Shanghai Changhai Hospital from August 2012 to February 2014 were retrospectively analyzed. According to the level of postoperative serum creatinine AKI group and non-AKI group, single factor and multivariate Logistic regression analysis of percutaneous nephroscope holmium laser lithotripsy AKI risk factors. RESULTS: A total of 405 patients with percutaneous nephrolithotomy underwent holmium laser lithotripsy. AKI occurred in 27 patients (6.7%, 27/405). Univariate analysis showed that the mean age of AKI group was higher than that of non-AKI group [(54.63 ± 8.97) vs. (49.03 ± 12.29) years, P = 0.021]; AKI group was higher than non-AKI group (18.5% vs.6.1 %, P = 0.014). The proportion of isolated kidney in AKI group was higher than that in non-AKI group (18.5% vs.3.7%, P = 0.002). Further multivariate analysis showed that diabetic patients (OR = 5.409), isolated kidney (OR = 6.997) and preoperative eGFR <60ml · min-1 · 1.73m -2 (OR = 2.649) Independent risk factors for acute kidney injury after gravel operation. Conclusion: The reduction of diabetic nephropathy and eGFR (<60 ml · min -1 · 1.73 m -2) is an independent risk factor of AKI after percutaneous nephroscope holmium laser lithotripsy.