經(jīng)皮腎鏡術(shù)后感染性休克與尿中亞硝酸鹽關(guān)系的分析

【摘 要】 目的 總結(jié)經(jīng)皮腎鏡碎石取石術(shù) PCNL治療經(jīng)驗(yàn)，探討PCNL術(shù)后感染性休克與亞硝酸鹽陽性患者處理方法及預(yù)防措施。方法 收集采用PCNL治療的48例腎結(jié)石亞硝酸鹽陽性患者的臨床資料，進(jìn)行回顧性分析，患者共行48例次PCNL 其中5例因術(shù)后結(jié)石殘留行二次手術(shù)。結(jié)果 術(shù)前經(jīng)早期抗感染治療亞硝酸鹽轉(zhuǎn)陰性32例患者術(shù)后發(fā)生感染性休克1例。術(shù)前經(jīng)抗感染治療亞硝酸鹽未轉(zhuǎn)陰性16患者術(shù)后發(fā)生感染性休克7例。結(jié)論 感染性休克是PCNL術(shù)后最嚴(yán)重的并發(fā)癥，要充分重視并早期采取積極防治措施，術(shù)前常規(guī)留置中段尿培養(yǎng)和進(jìn)行藥物敏感試驗(yàn)，術(shù)中采用合適的工作通道，術(shù)后進(jìn)一步抗感染治療，避免感染性休克的發(fā)生。

【關(guān)鍵詞】 感染性休克；經(jīng)皮腎；亞硝酸鹽

【中圖分類號】 R699 【文獻(xiàn)標(biāo)識(shí)碼】 B

The analysis of nitrite between shock and urinary infection after percutaneous nephrolithotomy

Zou Shenglong Deng Ruoping

（Central Hospital of Hunan Yongzhou， North Hospital Urology， Hunan，Yongzhou，425000）

【Abstract】 Objective Summary of percutaneous nephrolithotomy PCNL treatment experience，Shock and nitrite positive patients in treatment and prevention of postoperative infection of PCNL. Method Collection using PCNL treatment of 48 cases of renal calculi nitrite clinical data of the patients with positive，Retrospective analysis，Patients with a total of 48 cases of PCNL including 5 cases for the two operation of residual stones after operation. Results Preoperative early anti infection treatment nitrite turned negative in 32 patients occurred in 1 patients with septic shock。Preoperative after anti infection treatment of nitrite did not turn negative in 16 patients after operation occurred in 7 patients with septic shock. Conclusion Septic shock is one of the most serious complications after PCNL，F(xiàn)ull attention must be paid to early and take effective measures to，Routine preoperative indwelling urine culture and drug sensitive test，The working channel suitable operation，After further anti infection treatment，To avoid the occurrence of septic shock.

【Keywords】 Septic shock；Percutaneous；renal Nitrite

近年來由于微創(chuàng)技術(shù)推廣，腔內(nèi)碎石取石技術(shù)的發(fā)展，經(jīng)皮腎鏡鈥激光碎石取石術(shù)PCNL，逐漸取代開放手術(shù)，成為治療腎結(jié)石的可靠方法，但術(shù)后出現(xiàn)并發(fā)癥也在不斷增加，其中以術(shù)后感染性休克最為嚴(yán)重，若處理不及時(shí)可引起嚴(yán)重并發(fā)癥甚至死亡，在臨床工作中如何預(yù)防、診斷、治療和及時(shí)處置術(shù)后感染是值得我們進(jìn)一步總結(jié)，現(xiàn)將永州市中心醫(yī)院（南北兩院）對48名腎結(jié)石患者尿中亞硝酸鹽陽性行PCNL治療及術(shù)后感染情況報(bào)告如下：

1 資料與方法

1.1 一般資料 選擇我院2010 年4 月-2013 年4 月行PCNL 患者共48例，其中男28例，女20 例，平均年齡（63.2+18.5）歲。患者術(shù)前均行泌尿系B 超、CT、排泄性尿路造影（IVP）或尿路平片（KUB）等檢查確診為腎結(jié)石?！?br>