上尿路结石行输尿管镜碎石术后尿源性脓毒血症的早期诊治

doi:10.3969/j.issn.1006-7795.2024.05.019

首都医科大学学报 ›› 2024, Vol. 45 ›› Issue (5): 870-874.doi: 10.3969/j.issn.1006-7795.2024.05.019

• 泌尿系疾病的综合治疗 • 上一篇下一篇

上尿路结石行输尿管镜碎石术后尿源性脓毒血症的早期诊治

张大坤¹, 张洪波¹, 董德鑫^2*, 高翔¹, 郑瀚¹, 张浪¹

1.北京市隆福医院泌尿外科，北京100010；2.中国医学科学院北京协和医院泌尿外科，北京 100730

收稿日期:2024-05-26 出版日期:2024-10-21 发布日期:2024-10-18
通讯作者: 董德鑫 E-mail:winterheart@163.com
基金资助:
首都卫生发展科研专项项目(首发2020-2-7014）。

Early diagnosis and treatment of urinary sepsis after ureteroscopic lithotripsy of upper urinary tract stones

Zhang Dakun¹, Zhang Hongbo¹, Dong Dexin^2*, Gao Xiang¹, Zheng Han¹, Zhang Lang¹

1. Department of Urology, Beijing Longfu Hospital, Beijing 100010, China; 2. Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China

Received:2024-05-26 Online:2024-10-21 Published:2024-10-18
Supported by:
This study was supported by Capital's Funds for Health Improvement and Research(First release 2020-2-7014）.

摘要/Abstract

摘要： 目的探讨上尿路结石行输尿管镜碎石术后尿源性脓毒血症的早期诊治策略。方法回顾性分析北京市隆福医院2019年1月至2023年8月诊治的32例上尿路结石输尿管镜碎石术后发生尿源性脓毒血症的患者资料，以对照原则按1∶2比例匹配选取64例同期手术而未出现尿源性脓毒血症的患者临床资料进行统计分析，分析引发尿源性脓毒血症的危险因素和早期诊治策略。结果通过检测术后2、6、12 h血白细胞和降钙素原作为早期预警的关键指标，早期诊断尿源性脓毒血症，早期治疗给予静脉滴注美罗培南（1.0 g，每8 h 1次）抗感染治疗，并液体复苏治疗和维持出入量平衡，所有32例尿源性脓毒血症患者均成功康复出院。单因素分析提示，年龄（≥60岁）、手术时间（≥120 min）、女性、术前尿培养阳性、术前发热、结石直径（≥20 mm）是上尿路结石术后尿源性脓毒血症的独立危险因素（P<0.05）。结论上尿路结石输尿管镜碎石术后相关尿源性脓毒血症是临床急危重症。术前高危因素包括年龄≥60岁、女性、术前尿培养阳性、术前发热和结石直径≥20 mm，术后2、6、12 h血白细胞和降钙素原可以作为早期预警的关键指标，术后早期发现并积极抗感染治疗是诊治尿源性脓毒血症的关键措施。

关键词: 上尿路结石, 输尿管镜, 尿源性脓毒血症, 危险因素, 早期诊治

Abstract: Objective To investigate the early diagnosis and treatment strategies for urinary sepsis after ureteroscopic lithotripsy for upper urinary tract stones.Methods A retrospective analysis was conducted on the data of 32 patients with upper urinary tract stones who developed urinary sepsis after ureteroscopic lithotripsy in Beijing Longfu Hospital from January 2019 to August 2023. Using a control principle and a 1∶2 ratio, clinical data of 64 patients who underwent surgery during the same period without urinary sepsis were selected for statistical analysis, and the risk factors and early diagnosis and treatment strategies for urinary sepsis were analyzed.Results By detecting blood white blood cells and procalcitonin at 2, 6, and 12 hours after surgery as key indicators for early warning, urinary sepsis was diagnosed early. Early treatment was given intravenous meropenem (1.0 once every 8 hours) as anti infective therapy, and fluid resuscitation therapy was performed to maintain the balance of inflow and outflow. All 32 patients with urinary sepsis recovered successfully. Univariate analysis suggests that age (≥ 60 years), surgery time (≥ 120 min), female gender, positive preoperative urine culture, preoperative fever, and stone diameter (≥ 20 mm) are independent risk factors for postoperative urinary sepsis in upper urinary tract stones (P<0.05). Conclusions Post ureteroscopic lithotripsy for upper urinary tract stones is associated with urinary sepsis, which is a clinical emergency and critical condition. Preoperative high-risk factors include age ≥ 60 years, female gender, positive urine culture before surgery, preoperative fever, and stone diameter ≥ 20 mm. Blood white blood cells and procalcitonin at 2, 6, and 12 h after surgery can be key indicators for early warning. Early detection and active anti infection treatment after surgery are key measures for the diagnosis and treatment of urinary sepsis.

Key words: upper urinary tract stones, ureteroscope, urinary sepsis, risk factors, early diagnosis and treatment

中图分类号:

张大坤, 张洪波, 董德鑫, 高翔, 郑瀚, 张浪. 上尿路结石行输尿管镜碎石术后尿源性脓毒血症的早期诊治[J]. 首都医科大学学报, 2024, 45(5): 870-874.

Zhang Dakun, Zhang Hongbo, Dong Dexin, Gao Xiang, Zheng Han, Zhang Lang. Early diagnosis and treatment of urinary sepsis after ureteroscopic lithotripsy of upper urinary tract stones[J]. Journal of Capital Medical University, 2024, 45(5): 870-874.

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上尿路结石行输尿管镜碎石术后尿源性脓毒血症的早期诊治

Early diagnosis and treatment of urinary sepsis after ureteroscopic lithotripsy of upper urinary tract stones

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