经尿道手术后尿脓毒血症的诊治分析

Analysis of diagnosis and treatment for urosepsis after transurethral operation

摘要:

目的  探讨经尿道手术后发生尿脓毒血症的原因和防治措施。方法  回顾性分析2007年9月-2015年6月12例经尿道手术后发生尿脓毒血症患者的临床资料。结果  12例患者中，行经尿道前列腺切除术3例，行输尿管硬镜钬激光碎石术8例，行输尿管软镜钬激光碎石术1例，均出现不同程度的尿脓毒血症。7例患者术后转入ICU，均给予抗休克和抗感染等治疗。1例经尿道前列腺切除术后患者出现多器官功能衰竭，于术后10 d死亡，1例输尿管软镜钬激光碎石术后患者出现多器官功能障碍综合征，术后出现心肌不可逆损害，其余10例患者术后1～3周的血常规、尿常规、血培养、尿培养、降钙素原均恢复正常，最后治愈出院。结论  尿脓毒血症是经尿道手术后的严重并发症，应提高警惕，早期诊断和合理治疗是关键，血清降钙素原（PCT）测定可作为预警指标。

Abstract:

Objective To investigate the etiology, prevention and treatment of measures urosepsis after transurethral operation. Methods Clinical data of 12 patients with urosepsis after transurethral operation from September 2007 to December 2015 were retrospectively analyzed. Results Among the 12 patients, 3 received transuretheral resection of prostate, 8 received ureteroscopy with holmium laser lithotripsy, and 1 received digital flexible ureteroscopy with holmium laser lithotripsy. They all had different degrees of urosepsis. After ope-
ration 7 patients were transferred into ICU. Of the 12 patients, 1 died of multiple organ failure 10 days after operation, 1 suffered from multiple organ dysfunction syndrome with irreversible heart damage, the rest 10 all recovered well within 1 to 3 weeks after operation. Conclusions Urosepsis is one of the serious complications of transurethral operation, which we should pay more attention to. However, early diagnosis and treatment are the key points. The level of procalcitonin (PCT) can be an early warning sign for urosepsis.