通过皮肤进行结石切除术后发生败血性休克的高风险患者
Alexandre Danilovic1, Lucas Piraciaba Cassiano Dias1, Fabio Cesar Miranda Torricelli1
1Departamento de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil.
概括
皮肤结石切除术 (PCNL) 患者患有较大的结石,尿液培养呈阳性,并具有较高的并发症评分,面临着感染性休克的风险增加. 仔细的术后管理对于预防PCNL后的严重并发症至关重要.
科学领域:
- 泌尿器科 泌尿器科 泌尿器科 泌尿器科
- 腎臟病學 (nephrology) 是一種醫學專業.
- 传染性疾病 传染性疾病
背景情况:
- 穿皮石切除术 (PCNL) 是一种常见的石切除手术.
- 尿道败血性休克是PCNL后的一种严重,危及生命的并发症.
- 确定手术前的风险因素对于患者管理至关重要.
研究的目的:
- 为了确定与PCNL后尿道败血性休克相关的危险因素.
- 为了对接受PCNL治疗结石患者的风险进行分层.
主要方法:
- 从2009年1月到2020年2月,对PCNL程序进行了回顾性分析.
- 纳入标准:18岁以上患有结石>15毫米的患者.
- 后勤回归分析以确定术后30天内感染性休克的危险因素.
主要成果:
- 在1424名患者中,尿道败血性休克发生在0.56%的患者.
- 显著的危险因素包括较高的查尔森并发症指数 (CCI),较大的石头大小 (≥35毫米),以及阳性手术前尿液培养.
- 患者的CCI>2,石头≥35毫米,和积极的尿液培养具有显著更高的风险 (OR 15.40).
结论:
- 较大的结石,阳性手术前尿液培养和升高的CCI是PCNL后败血性休克的关键危险因素.
- 风险分层对于优化术后护理至关重要.
- 积极的管理可以帮助预防严重的并发症,如败血症休克.
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