Related Factors Of Fever And Prophylaxis Policy After Percutaneous Nephrostolithotomy

Objective To analyze the related factors of fevers afterpercutaneous nephrostolithotomy(PCNL) and research the moreeffective prevention methods. Methods To make a retrospectiveanalysis of220cases who underwent PCNL for renal calculi from2009to2010(men126,women94,age between29-78years),thediameter were0.8-6cm, the average age and diameter were53years and3cm respectively. We analyzed the factors such as agestructure(>45years and <45years),stone situation(>2.0cm and<2.0cm),operation time(>60min and <60min),the perfusion ofpressure (>120mmHg and <120mmHg), and then we compared thefever rate between each factors. Results64cases were withfever after PCNL, whose temperature were over38.5℃，takingup29.1%.2cases were pyemia. Using urine culture examination.Escherichia coli13cases（20.3%）、Pseudomonas aeruginosa1cases（1.6%）、Klebsiella pneumoniae3cases（4.7%）、bacillustermo1cases（1.6%）、Pseudomonas putida2case（3.1%）、Staphylococcus aureus3cases （4.7%）、 Staphylococcusepidermidis1cases（1.6%）、Enterococcus faecium1case（1.6%）、Hemolytic streptococcus1case（1.6%）、Candida albicans3cases （4.7%）,The temperature of two cases reached up to40.0℃，HR>120/min，urine culture were positive，bacteriales were：Pseudomonas aeruginosa1case、Staphylococcus epidermidis1case，we diagnosed pyaemia septica，we used the moxifloxacinand Vancomycin respectively according to the drug sensitivetest,，they were cured in fine, nobdy was died.The stone>2cmin size got a fever rate of22.1%after operation, and the stonediameter <2.0cm was10.2%,;the operation time>60min and <60mingot a fever rate of27.4%and10.3%respectively; the perfusionof pressure>120mmHg and<120mmHg were27.7%and10.4%.Theabove-mentioned fever rates between each group had thestatistical significance(P<0.05),and the age>45years and<45years were28.6%and30%respectively, they had no statisticalsignificance. Conclusions The frequency of fever andinfection after PCNL are the common complication, sometimes canlead to a septicemia, so these factors must be taken intoaccount such as the stone diameter>2.0cm,the operationtime>60min,the volume of perfusate>20L,they may cause feverand infection easily. So the effective measures of preventingpost-operational fever should be taken, including usingbroad-spectrum antibacterial agents rationally before theoperation, the shorter operation time,low-pressure perfusion. If you met with the big stone, the long operation time, the morebleeding and the unclear horizon, you should not increase thepressure of irrigation, instead you can made the two-stageoperation, which can reduce the fever rate after operation.