【摘要】 目的探讨微通道自然低压在减少经皮肾镜碎石术(PCNL)后感染的临床价值。方法收集行PCNL治疗的138例上尿路结石患者临床资料,其中行微通道自然低压PCNL 62例(微通道自然低压组)、行常规标准通道PCNL 76例(标准通道组),对比2组患者手术时间、术中出血量、术后24 h生命体征、感染指标、拔管时间、清石效率的差异,分析2组术后尿源性脓毒血症发生情况。结果 2组患者均顺利完成手术,2组的手术时间、清石效率、体温、血压、呼吸频率比较差异均无统计学意义(P> 0.05)。与标准通道组相比,微通道自然低压组术中出血量较少、拔管时间较早,且心率、白细胞计数、血小板计数、CRP和降钙素原异常者比例均较低(P均<0.05)。术后微通道自然低压组出现尿源性脓毒血症1例(2%),标准通道组出现尿源性脓毒血症3例(4%),微通道自然低压组尿源性脓毒血症的发生率比标准通道组略有下降,但组间比较差异无统计学意义(P> 0.05)。出现尿源性脓毒血症的患者经积极补液、抗休克等处理,病情稳定,均痊愈出院,无术后死亡者。结论使用微通道自然低压行PCNL对患者损伤较轻,有助减少术后感染的发生。更多还原

【Abstract】 Objective To investigate the clinical value of microchannel natural low pressure in reducing urinary sepsis in percutaneous nephrolithotomy.Methods Clinical data of 138 patients with upper urinary stone undergoing percutaneous nephrolithotomy were retrospectively analyzed.Among them,62 cases received microchannel natural low pressure percutaneous nephrolithotomy(microchannel nature low pressure group) and 76 patients underwent conventional standard channel percutaneous nephrolithotomy(standard channel group).The operation time,bleeding volume,postoperative 24 h vital signs infection indicators,extubation time,and the stone removal efficiency were statistically compared between two groups.The incidence of postoperative urinary sepsis was analyzed in two groups.Results All patients in two groups successfully completed the surgery.The operation time,stone removal efficiency,temperature,blood pressure and respiratory frequency did not significantly difffer between two groups(all P > 0.05).Compared with the standard channel group,the bleeding volume was significantly less,the extubation time was considerably earlier,and the proportion of patients with abnormal heart rate,white blood cell count,platelet count,CRP and procalcitonin were remarkably lower in the microchannel natural low pressure group(all P < 0.05).One case(2%) of urinary sepsis appeared in the microchannel natural low pressure group,three cases(4%) of urinary sepsis occurred in the standard channel group.The incidence of urinary sepsis in the microchannel natural low pressure group was slightly decreased than that in the standard channel group without statistical significance(P > 0.05).Patients presenting with urinary sepsis were discharged after fluid infusion and antishock therapy.No patient died after surgery.Conclusion Microchannel natural low pressure percutaneous nephrolithotomy can mitigate surgical injury and reduce the risk of postoperative infection compared with the standard channel percutaneous nephrolithotomy.更多还原