Analysis Of Risk Factors For SIRS After Partially Tubeless Percutaneous Nephrolithotomy

Objective:To explore the risk factors and preventive strategies of systemic inflammatory response syndrome(SIRS)after partial tubeless percutaneous nephrolithotomy(PCNL).Methods:This study retrospectively analyzed the data of 161 patients with upper urinary tract stones who underwent unilateral first-stage partial tubeless PCNL from June2019 to December 2020 in the Department of Urology,the First Affiliated Hospital of Wannan Medical College.The occurrence of SIRS is divided into SIRS and non-SIRS groups.Based on the summary and analysis of previous studies on the risk factors of PCNL infection complications,the specific observation indicators selected include: age,gender,BMI,history of ipsilateral kidney surgery,preoperative renal fistula,preoperative urinary white blood cells,Preoperative urine culture,diabetes,renal insufficiency,hydronephrosis,calculus diameter,staghorn/cast calculus,calculus CT value,operation time,total flushing fluid,and remaining calculus.A single factor analysis was performed on all the factors in the study,and the chi-square test was used for comparison between groups,and the difference was statistically significant with P<0.05.Screening statistically significant factors as independent variables of multivariate analysis,using multivariate logistic regression model for correlation analysis,exploring the independent risk factors of SIRS after partial tubeless PCNL,and P<0.05 as the difference is statistically significant significance.Results:A total of 161 patients were included in this study,and a total of 42 patients(26.1%)developed SIRS after surgery.The results of univariate analysis(chi-square test)showed that: diabetes,preoperative urine culture positive,hydronephrosis,calculus diameter ≥30mm,cast/staghorn stones,operation time ≥90min,stone residues are related to the occurrence of SIRS(P<0.05).And gender,age ≥ 60 years,BMI ≥ 30 kg/m2,history of ipsilateral kidney surgery,preoperative nephrostomy,preoperative urine white blood cell positive,renal insufficiency,stone CT value ≥ 1000 Hu,perfusion fluid volume≥ 30 L,etc.The occurrence of urinary sepsis was not significantly correlated(P>0.05).Seven related factors selected by univariate analysis were used as independent variables to perform multivariate logistic regression analysis.The results showed that:diabetes,positive urine culture before operation,calculus diameter ≥30mm,and residual calculus are independent risk factors for SIRS after partial tubeless PCNLConclusion:With the development of technology,more and more doctors have begun to adopt partially tubeless PCNL,and its effectiveness and safety have also been confirmed.Systemic inflammatory response syndrome(SIRS)is one of the complications frequently encountered after PCNL.If there is no timely intervention and treatment,serious infection complications are likely to occur.There have been studies that have explored the predictive factors of various PCNL surgical infection complications,but there are few studies that specifically target the risk factors of SIRS after partial tubeless PCNL.Therefore,this study analyzed the clinical data of 161 cases of partially tubeless PCNL and found that diabetes,preoperative urine culture,stone diameter ≥30mm,and residual stone were independent risk factors for SIRS after partially tubeless PCNL.The analysis and discussion of these risk factors and preventive measures have important reference significance for the preoperative risk assessment,the prevention of serious infection complications and timely intervention of such surgical patients.