摘要
目的探讨经输尿管气压弹道碎石术后合并重症感染的早期诊疗方法,以减少经输尿管气压弹道碎石术后合并重症感染的发生。方法选择2012年1月-2015年12月收治的260例经输尿管气压弹道碎石术后合并重症感染患者为研究对象(观察组),另选同期经输尿管气压弹道碎石术后未发生感染的患者260例(对照组),比较两组患者的结石直径、尿液检查情况、术前感染情况、输尿管镜操作时间、手术时间、术中出血、术中灌注压、术后引流、碎石成功率及结石清除率。结果观察组术前结石>15mm和尿液检查呈阳性的患者(207例、215例)多于对照组(32例、39例),差异有统计学意义(P<0.05);观察组术前感染未控制和术后引流不畅的患者(195例、179例)多于对照组(14例、27例),差异有统计学意义(P<0.05);观察组手术时间、输尿管镜操作时间[(72.19±14.31)min、(72.07±16.11)min]多于对照组[(65.14±12.01)min、(35.53±14.21)min],观察组术中出血量[(24.65±3.27)ml]多于对照组[(18.21±2.32)ml],观察组术中灌注压[(81.28±7.01)mmHg]高于对照组[(65.42±6.73)mmHg],差异有统计学意义(P<0.05);观察组患者碎石成功率和结石排除率(77.31%、70.00%)均低于对照组(88.85%、82.31%),差异均有统计学意义(P<0.05)。结论结石直径较大、尿检阳性、术前感染未控制、手术时间过长、输尿管镜操作时间、术中出血量过多、术中灌注压过高、术后引流不畅易导致输尿管气压弹道碎石术后合并重症感染发生,在早期诊断和治疗过程中应给予有效的抗感染治疗,提高碎石技巧以及加强术后护理。
OBJECTIVE To explore the measures for early diagnosis and treatment of patients complicated with severe infection after ureteral pneumatic lithotripsy so as to reduce the incidence of the postoperative severe infection.METHODS From Jan 2012 to Dec 2015,a total of 206 patients who underwent the ureteral pneumatic lithotripsy and were complicated with postoperative severe infection were recruited as the study objects（the observation group）,meanwhile,260 patients who underwent the ureteral pneumatic lithotripsy but were not complicated with postoperative infection were set as the control group.The stone diameter,result of urine examination,prevalence of preoperative infection,time of ureteroscopy operation,operation duration,intraoperative hemorrhage,intraoperative perfusion pressure,postoperative drainage,success rate of gravel,and clearance rate of stones were observed and compared between the two groups of patients.RESULTS There were 207 patients with preoperative stone diameter more than 15 mm in the observation group and 32 patients in the control group,and there were 215 patients who were positive for urine examination in the observation group and 39 patients in the control group,with statistical significance（P〈0.05）.There were 195 patients without control of preoperative infection in the observation group and 14 patients in the control group,and there were 179 patients without smooth postoperative drainage in the observation group and 27 patients in the control group（P〈0.05）.The operation duration of the observation group was（72.19±14.31）min,longer than（65.14±12.01）min of the control group;the time of ureteroscopy operation of the observation group was（72.07±16.11）min,longer than（35.53±14.21）min of the control group.The intraoperative blood loss volume of the observation group was（24.65±3.27）ml,greater than（18.21±2.32）ml of the control group.The intraoperative perfusion pressure of the observation group was（24.65±3.27）mmHg,higher than（65.42±6.73）mmHg of the control group（P〈0.05）.The success rate of gravel of the observation group was 77.31%,lower than 88.85% of the control group;the clearance rate of stones of the observation group was 70.00%,lower than 82.31% of the control group（P〈0.05）.CONCLUSION The postoperative complication with severe infection would be induced by the long stone diameter,positive urine examination,without control of preoperative infection,long operation duration,time of ureteroscopy operation,excessive intraoperative blood loss,high intraoperative perfusion pressure,and without smooth postoperative drainage.It is necessary to conduct the effective anti-infection therapy during the early diagnosis and treatment,sharpen the gravel skills,and intensify the postoperative nursing.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2017年第9期2060-2063,共4页
Chinese Journal of Nosocomiology
基金
湖北省卫生厅基金资助项目(WX16E07)
