【摘要】：目的探討經(jīng)皮腎鏡碎石術(shù)(percutaneous nephrolithotomy,PCNL)術(shù)后發(fā)生全身炎癥反應(yīng)綜合征(systemic inflammatory response syndrome,SIRS)的危險因素,以便更好地預(yù)防臨床中PCNL術(shù)后SIRS的發(fā)生。方法收集山東大學齊魯醫(yī)院泌尿外科2014年1月—2016年10月收治的泌尿系結(jié)石并行PCNL的患者信息。根據(jù)術(shù)后是否發(fā)生SIRS分為SIRS組和非SIRS組。分析比較2組患者間性別、年齡、糖尿病史、手術(shù)時間、結(jié)石大小、單發(fā)或多發(fā)結(jié)石、腎積水和術(shù)前尿培養(yǎng)結(jié)果與術(shù)后SIRS的相關(guān)性,探討SIRS的危險因素。統(tǒng)計分析采用描述性統(tǒng)計分析、單因素分析(卡方分析、獨立樣本t檢驗)和多因素Logistic回歸分析。結(jié)果本研究共入選190例患者,術(shù)后SIRS共發(fā)生40例(21.1%)。單因素分析的結(jié)果顯示,糖尿病史(p=0.023)、手術(shù)時間(p=0.034)、結(jié)石大小(p0.001)和術(shù)前尿培養(yǎng)(p0.001)與PCNL術(shù)后SIRS發(fā)生之間顯著相關(guān),患者性別、年齡、單發(fā)或多發(fā)結(jié)石、是否合并腎積水與PCNL術(shù)后SIRS發(fā)生無明顯相關(guān)性(p0.05)。納入糖尿病史、手術(shù)時間、結(jié)石大小和術(shù)前尿培養(yǎng)4個因素的logistic回歸中,糖尿病史和結(jié)石大小是SIRS的獨立危險因素。ROC曲線顯示結(jié)石大小和糖尿病史兩因素具有一定的聯(lián)合預(yù)測價值(AUC=0.743,95%CI:0.653-0.833)。結(jié)論PCNL術(shù)后SIRS的發(fā)生與患者有無糖尿病及結(jié)石大小有密切關(guān)系,需引起泌尿外科醫(yī)生高度重視。
[Abstract]:Objective to investigate the risk factors of systemic inflammatory response syndrome (systemic inflammatory response syndrome,SIRS) after percutaneous nephrolithotripsy (percutaneous nephrolithotomy,PCNL) in order to prevent SIRS after PCNL. Methods data of patients with urinary calculi treated with PCNL from January 2014 to October 2016 in Qilu Hospital of Shandong University were collected. SIRS was divided into SIRS group and non-SIRS group according to whether it occurred or not. Sex, age, history of diabetes, operation time, stone size, single or multiple stones, hydronephrosis and urine culture before and after SIRS were analyzed and compared between the two groups, and the risk factors of SIRS were discussed. Descriptive statistical analysis, single factor analysis (chi-square analysis, independent sample t-test) and multivariate Logistic regression analysis were used in the statistical analysis. Results of 190 patients, 40 (21. 1%) had SIRS after operation. Univariate analysis showed that the history of diabetes mellitus (p0.023), operative time (p0.034), stone size (p0.001) and preoperative urine culture (p0.001) were significantly correlated with the occurrence of SIRS after PCNL. There was no significant correlation between hydronephrosis and SIRS after PCNL (p0.05). The history of diabetes, the time of operation, the size of stone and the urine culture before operation were included in logistic regression. Diabetes history and stone size were independent risk factors of SIRS. ROC curve showed that both stone size and diabetes history had combined predictive value (AUC=0.743,95%CI:0.653-0.833). Conclusion the incidence of SIRS after PCNL is closely related to diabetes mellitus and stone size, which should be paid more attention to by urologers.
【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R699

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