输尿管软镜碎石术后脓毒血症风险评分系统的初步建立*

Establishment of a risk scoring system for sepsis after ureteroscopic lithotripsy*

摘要:

目的 通过术前危险因素建立一个术前风险评分系统，预测输尿管软镜碎石术后脓毒血症发生的风险。方法 选取2015年1月—2018年6月石河子大学第一附属医院泌尿外科行输尿管软镜碎石术患者的临床资料，根据输尿管软镜碎石术后脓毒血症危险因素Meta分析结果，以女性、糖尿病、术前尿培养阳性、结石直径>1?cm、既往结石手术史5个因素关联强度不同进行赋值，初步建立输尿管软镜术后脓毒血症风险评分系统（FURSS），运用受试者操作特征（ROC）曲线对该评分系统的判别性及敏感性进行验证，并根据约登指数进行危险度分组。结果 女性、糖尿病、术前尿培养阳性、结石直径>1?cm、既往结石手术史5个因素赋值分别为2、2、3、2、2，ROC曲线下面积为0.827（95% CI：0.708，0.947，P?=0.000），当评分<4.5分时，敏感性为84.6%、特异性为85.8%。结论 该研究所建立的FURSS对输尿管软镜术后发生脓毒血症有良好预测价值，当评分<4.5分时患者术后脓毒血症风险较高。

Abstract:

Objective To establish a preoperative risk scoring system to predict the risk of sepsis after flexible ureteroscopic lithotripsy. Methods Based on meta analysis of risk factors for sepsis after flexible ureteroscopic lithotripsy, the risk scoring system for sepsis was initially established by assigning the strength of five factors including female, diabetes mellitus, preoperative positive urine culture, stone diameter > 1?cm, and previous stone operation history. The clinical data of patients who underwent ureteroscopic lithotripsy in the Department of Urology, First Affiliated Hospital of Shihezi University from January 2015 to June 2018 were collected. Results Five risk factor including female, diabetes mellitus, preoperative urine culture positive, stone diameter > 1?cm, and previous stone operation history were assigned 2, 2, 3, 2, 2, respectively. ROC curve area was 0.827 (95% CI: 0.708, 0.947, P?=?0.00). When the score was greater than 4.5, the sensitivity and specificity was 84.6% and 85.8%, respectively. Conclusions The risk score systerm named FURSS exerts good predictive value for sepsis after ureteroscopic surgery.