经皮肾镜碎石术后感染性休克患者开放肾造瘘管必要性的研究

Necessity of opening the nephrostomy tube for patients with septic shock after percutaneous nephrolithotomy

摘要:

目的探讨经皮肾镜碎石术（PCNL）术后留置双J管患者发生感染性休克开放肾造瘘管的必要性，为PCNL术后感染性休克的治疗提供参考依据。方法选取某院2015年1月1日—2016年12月30日因 PCNL术后并发感染性休克患者60例，将患者随机分为肾造瘘管夹闭组（30例）与肾造瘘管开放组（30例），收集两组相关临床资料进行分析。结果两组患者治疗24 h后心率(HR)、平均动脉压（MAP）、氧饱和度（SpO2）、血清乳酸(Lac)、每小时尿量均较治疗前明显改善（均P＜0.05）；开放组患者治疗24 h后HR、MAP、SpO2、Lac、每小时尿量与夹闭组比较，差异均有统计学意义（均P＜0.05）。两组患者治疗3 d后血清降钙素原（PCT）、C反应蛋白（CRP）均较治疗前明显下降（均P＜0.05）；开放组患者治疗3 d后血清PCT、CRP均低于夹闭组(均P＜0.05 )；两组患者治愈好转率均为100.00%，开放组患者术后住院时间和拔管时间均短于夹闭组，总住院费用少于夹闭组，差异均有统计学意义（均P＜0.05）。结论PCNL术后感染性休克的患者在常规留置双J管的基础上开放肾造瘘管是有必要的。

Abstract:

ObjectiveTo explore the necessity of opening nephrostomy tube for patients with septic shock following the indwelling doubleJ stent of postpercutaneous nephrolithotomy (PCNL), and provide reference for the treatment of septic shock after PCNL. Methods60 patients with septic shock after PCNL in a hospital from January 1, 2015 to December 30, 2016 were chosen, patients were randomly divided into clipping nephrostomy tube group (clipping group, n=30) and opening nephrostomy tube group (opening group, n=30), clinical data of two groups of patients were collected and analyzed. ResultsAfter 24hour treatment, heart rate (HR), mean arterial pressure (MAP), oxygen saturation (SpO2), serum lactate (Lac), and hourly urine volume all improved in both groups of patient compared with pretreatment(all P<0.05); HR, MAP, SpO2, Lac, and hourly urine volume in opening group after 24hour treatment were all significantly different from clipping group (all P<0.05). Levels of serum procalcitonin (PCT) and Creactive protein (CRP) in two groups after 3day treatment decreased significantly compared with pretreatment (both P<0.05); PCT and CRP levels in opening group after 3day treatment were both significantly lower than clipping group (both P<0.05); cure rate of two groups were both 100.00%, hospitalization time and extubation time in opening group were both shorter than clipping group, and cost was less than clipping group, difference were all significant(all P<0.05). ConclusionOpening nephrostomy tube on the basis of indwelling doubleJ stent is necessary for patients with septic shock after PCNL.