摘要
目的总结尿源性败血症的发病特点、早期症状及诊治经验，降低发生率及病死率。方法回顾性分析浙江大学附属第一医院2008年8月至2012年4月因泌尿系疾病治疗过程中并发的尿源性败血症30例患者的临床资料，探讨尿源性败血症的早期症状、早期诊治措施及转归。30例中，男10例，女20例，平均年龄55．7岁。其中，输尿管结石行钬激光碎石术后3例，一侧输尿管梗阻后继发3例，经尿道前列腺电切（TURP）术后2例，经尿道膀胱肿瘤电切（TURB）术后1例，膀胱全切＋Bricker膀胱术后3例，经皮肾镜碎石（PCNL）术中、术后18例。结果12例PCNL患者术中即出现非出血因素引起的血压明显下降。26例术后2h即出现寒战、高热。血压下降和高热是尿源性败血症的最早症状。经积极抗感染和对症处理，27例抢救成功，3例死亡，1例为输尿管镜下钬激光碎石术后，1例为PCNL术后，1例为TURP术后，病死率10％。结论尿源性败血症起病隐匿，一旦发生，则发展迅速，难以逆转，早期诊治有利于提高抢救成功率。
Objective To explore the characteristics, early symptoms and valuable experiences in the diagnosis and treatment of urine-induced sepsis. Methods The clinical data of 30 cases of urine-induced sepsis between August 2008 and April 2012 were reviewed retrospectively. Among them, YAG laser lithotripsy （ n = 3 ） and transurethral prostatic resection （TURP） （ n = 2） were performed. One case was after transurethral resection of bladder （TURB）. There were 3 cases after cystectomy and Bricker and another 18 during and after percutaneous nephrolithotomy （PCNL）. Results A total of 12 PCNL cases have significant drop in blood pressure during operation with non-bleed causes. A total of 26 cases developed symptoms of chills and high fever after 2 hours of surgery. The earliest symptoms of urine-induced sepsis were decline in blood pressure and high fever. After resistance to infection and symptomatic treatment actively, 27 patients were rescued successful （90%）, 3 patients died （10%）. Among the 3 deceased patients, 1 case was after YAG laser lithotripsy under ureteroscope, 1 case was after PCNL, 1 case was after TURP. Conclusions The onset of urine-induced sepsis onset may he insidious. But this condition deteriorates rapidly and it is rather difficult to reverse. Most cases could be managed when the onset characteristics were recognized early. Prevention and early treatment are keys of lowering the mortality.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2013年第10期772-774,共3页
National Medical Journal of China
基金
国家临床重点专科建设项目
关键词
脓毒症
泌尿外科手术
尿源性败血症
早期症状
Sepsis
Urologic surgical procedures
Urine-induced sepsis
Early symptoms
