输尿管镜碎石术后并发全身炎症 反应综合征的危险因素分析

Evaluation of risk factors of postoperative systemic inflammatory response syndrome after ureteroscopy

摘要:

目的 探讨输尿管镜碎石术后并发全身炎症反应综合征的危险因素。方法 回顾性分析2014 年1 月-2016 年12 月在该院确诊为输尿管结石并接受输尿管镜碎石术治疗的206 例患者的临床资料。根据术后 是否发生全身炎症反应综合征（SIRS）分为SIRS 组和非SIRS 组，比较两组患者相关临床指标的差异，并对可 能与SIRS 有关的因素进行多因素Logistic 回归分析。结果 术后SIRS 发生率为16.02%；两组的术前尿培养结果、 结石大小和手术时间比较，差异有统计学意义（P <0.05），术后24 h 两组的血降钙素原、细菌内毒素浓度比较， 差异有统计学意义（P <0.05），SIRS 组均高于非SIRS 组；多因素Logistic 回归分析结果显示结石大小[O^R= 1.67（95%CI ：1.08，2.54），P =0.002]、手术时间[O^R=2.08（95%CI ：1.54，2.73），P =0.000]、术前尿细菌培 养[O^R=2.85（95%CI ：2.12，3.74），P =0.000]、术后24 h 血降钙素原[O^R=5.24（95%CI ：2.21，11.35），P = 0.000]、及细菌内毒素[O^R=2.68（95%CI ：1.98，3.40），P =0.000] 与术后SIRS 的发生具有相关性。结论 输 尿管镜碎石术后并发全身炎症反应综合征受多种因素的影响，术前中段尿细菌培养结果、结石大小、手术时间、 术后血降钙素原及细菌内毒素水平是术后发生SIRS 的危险因素。

Abstract:

Objective To assess the risk factors for postoperative systemic inflammatory response syndrome (SIRS) in patients undergoing ureteroscopy for ureteral calculi. Methods A retrospective analysis of clinical data of 206 patients undergoing ureteroscopy for ureteral calculi in our department from January 2014 to December 2016 was performed. All patients were categorized into a SIRS group and a non-SIRS group according to postoperative SIRS status. The potential risk factors of SIRS were compared between the two groups. Then multivariable logistic regression analysis was performed, and odds ratio (O^R) and 95% confidence interval (95% CI) were calculated to identify the independent risk factors. Results The incidence of postoperative SIRS of the observation group was 16.02%. The SIRS group appeared to have significantly larger stone size, longer operative time and higher levels of procalcitonin (PCT) and endotoxin as compared with the non-SIRS group (P < 0. 05). After multivariable logistic regression analysis, stone size [O^R = 1.67 (95% CI: 1.08, 2.54), P = 0.002], operative time [O^R = 2.08, (95% CI: 1.54, 2.73), P = 0.000], urinary calculi composition [O^R = 2.85 (95% CI: 2.12, 3.74), P = 0.000], serum procalcitonin 24 h after operation [O^R = 5.24 (95% CI: 2.21, 11.35), P = 0.000] and bacterial endotoxin [O^R = 2.68 (95% CI: 1.98, 3.40), P = 0.000] were considered as independent risk factors of SIRS after ureteroscopy. Conclusions A variety of factors affect the incidence of SIRS after undergoing ureteroscopy. Urinary calculi composition, stone size, operative time, postoperative procalcitonin (PCT) and endotoxin levels are independent risk factors for post-operative SIRS.