Systemic Inflammatory Response Syndrome Of The Risk Factors Of Sepsis After Percutaneous Nephrolithotripsy And Anesthesia Related Factors

Objective:Urinary calculus is a common disease in Department of Urology,including kidney stones and ureteral calculi,percutaneous nephrolithotomy(percutaneous nephrolithotomy,PCNL)surgical approach to the treatment of this disease is one of the most commonly used,with high efficiency,safety,high stone removal rate,has been widely carried out in the clinical use of,but a series of complications,such as hemorrhage often occurs after PCNL,infection,water intoxication,ureteropelvic junction stricture,urinary extravasation and so on,which is the most serious complication of infection,can be life-threatening,systemic inflammatory response syndrome complicated with infection(systemic inflammatory response syndrome,SIRS),which confirmed the presence of bacteria or highly suspicious for infection,sepsis.Therefore,when the PCNL SIRS after infection with that evolution of urosepsis,greatly increased the mortality rate,hospitalization time and treatment costs.The research on the PCNL,the source of urinary sepsis is the most frequently reported reason for perioperative death,so it has more and more surgeons and anesthesiologists on urinary.There are reports in the literature,there are about 21 to 32.1%of patients complicated with postoperative fever symptoms,about 0.3?4.7%of patients progressed of urosepsis,then become septic shock or multiple organ failure,even death.In this study,556 patients with PCNL were retrospectively analyzed to understand the risk factors of systemic inflammatory response syndrome after PCNL,and to explore the related factors and prevention strategies of perioperative anesthesia.Methods:Through the acquisition in March 1,2015?February 29,2016 in our hospital 556 cases underwent renal calculi in patients with percutaneous nephrolithotomy in the medical records of the gender,history of diabetes,urine routine and urine culture results,rehydration stone surgery,intraoperative hypotension,staghorn calculi,preoperative hydronephrosis,age,preoperative serum creatinine,stone size,the operative time,volume,extubation time,recovery room temperature(the patient's body temperature was measured when the patient was in the recovery room)and other factors,and the risk factors of anesthesia related factors of systemic inflammatory response syndrome research methods logistic regression analysis after percutaneous nephrolithotomy.Results:The study included 556 patients,81 patients(14.6%)had postoperative SIRS,including non SIRS group(475 cases),293 males and 182 females,mean age 52.84 ±11.31 years old.Including 3 cases of staghorn calculi,preoperative routine urine test was positive in 414 cases;51 cases of urine culture positive rate,serum creatinine was 89.46 ± 46.49U/L,1.54 ± 0.75cm stone diameter,hydronephrosis in 374 cases;group SIRS(81 cases)male 40 cases,female 41 cases,mean age 52.71 ± 11.33 years old;12 cases of staghorn calculi preoperative urine routine,73 cases were positive;preoperative urine culture positive rate in 24 cases,serum creatinine was 106.18 ± 91.15U/L,the diameter of the calculi was 1.78±0.73cm,62 cases of hydronephrosis;anesthesia and resuscitation:non SIRS group(475 cases)intraoperative hypotension occurred in 115 cases,intraoperative fluid volume of 1158.69 ± 350.38ml the operation time,extubation time was 61.86 ± 21.61min,30.45±21.66min,recovery room temperature average 36.102±0.506 C.In group SIRS(81 cases),the incidence of intraoperative hypotension occurred in 40 cases,fluid infusion volume was 1018.52 ± 320.59ml,operation time was 70.51 ± 30.5min,extubation time was 31.37 ± 19.26min,the average temperature of resuscitation room was 35.998 ± 0.589.Single factor logistic regression analysis showed that preoperative creatinine is abnormal,stone size,cast stone,whether urine culture positive,whether women,urine positive,whether intraoperative fluid pressure,intraoperative volume,operation time and recovery room temperature of 10 for P(P value =0.1 value<0.1 the extent of>0.1 to be removed).Then select the 10 factors multi factor logistic regression showed that the preoperative creatinine abnormality,stone size,cast stone,urine culture positive and intraoperative hypotension were risk factors of systemic inflammatory response syndrome after PCNL.Conclusion:The preoperative creatinine abnormality,stone size,cast stone,urine culture positive and intraoperative hypotension were high risk factors of systemic inflammatory response syndrome after PCNL,according to the anesthesia related factors,to strengthen the supervision of perioperative anesthesia,improve the prevention strategy of recognition.