Analysis Of Risk Factors And Prevention Strategies Of Urinary Sepsis After Percutaneous Nephrolithotomy Under Constant Pressure Of Perfusion

Purpose:The aim of this study was to investigate the risk factors and strategy of prevention and treatment of urinary sepsis after percutaneous nephrolithotomy under constant pressure of perfusion.Method:A total of 496 patients who underwent percutaneous nephrolithotomy under constant pressure of perfusion in our hospital were analyzed retrospectively.The relationship between age,gender,preoperative urine culture,stone burden,staghorn calculus,operation time,intraoperative perfusion fluid volume,calculus in stenosis kidney calices and postoperative urinary sepsis were analyzed.Result:496 patients of PCNL under constant pressure of perfusion with postoperative urinary sepsis occurred in 16 patients,the incidence was 3.2%.Univariate analysis showed that compared with the control group,group of urosepsis in these factors there was significant difference(P<0.05),which include of female,stone burden(>800mm2),preoperative positive urine culture,operation time(> 90min),perfusion liquid volume during operation(> 20L),calculus in stenosis kidney calices.Multivariate Logistic regression analysis showed that preoperative positive urine culture,stone burden(>800mm2),operation time(>90min)and calculus in stenosis kidney calices are independent risk factors for urosepsis after percutaneous nephrolithotomy(P<0.05).Conclusion:Preoperative positive urine culture,stone burden(>800mm2),operation time(>90min),calculus in stenosis kidney calices are independent risk factors for urosepsis after percutaneous nephrolithotomy under constant pressure of perfusion.In addition,female and perfusion liquid volume during operation(> 20L)were also associated with the occurrence of urosepsis after percutaneous nephrolithotomy under constant pressure of perfusion.In view of these risk factors,we should do like this:(1)Preoperative.When the patient appears positive urine culture,should be actively anti-infection treatment,if necessary,double J tube and(or)renal fistula should be retained.we should pay attention to the patient's underlying diseases,especially female patients,and strict control of the disease(2)Intraoperative.We should strict control the operation time,reduce perfusion pressure and reduce the amount of perfusion,if necessary,staging surgery;when calculus in stenosis kidney calices is treated,extend the neck of stenosis kidney calices and then place the peel-away sheath in the cup as far as possible to ensure smooth flow of perfusate;According to the specific situation of intraoperative renal pelvis urine,appropriate use of glucocorticoids and diuretics.(3)Postoperative.Smooth drainage to be ensured after surgery.When the occurrence of urosepsis after PCNL,immediately anti-infection and fluid resuscitation.when the aggravation of the situation,with vasoconstrictor drugs,vasoactive drugs and hormones,and so on.Then transfer to ICU treatment as soon as possible.