Analysis Of Risk Factors Of SIRS After Urolithiasissurgery And Intervention Of Integrated Chinese And Westernmedicine

Objective1.Exploring the risk factors ofsystemic inflammatory response syndrome(SIRS)after urolithiasis surgery,and establisha model of logistic regression equation according the result of multivariate analysisto predict the probability of SIRS after urolithiasis surgery,which is one of the inclusion criterion to the second part(integrated Chinese and western medicine SIRS)of the study.2.Usingthe model of logistic regression equation derived from the first part(risk factor analysis)of the study,the high-risk groups with a postoperativepredicted incidence of SIRS more than 50% were included in a prospective studyto observe the clinical efficacy of integrated Chinese and Western medicine intervention on SIRS,which for exploring the effective program to prevent and treat SIRS.MethodsPart I:Through retrospective research methods,103 cases of postoperative urinary calculi complicated by SIRS were collected as observation cases,which in the Department of Urology,First Affiliated Hospital of Guangzhou University of Chinese Medicine from January 1,2014 to December 31,2016;A total of 124 cases of postoperative urinary calculi without SIRS were included as control cases by systematic sampling.The collected case data were input into the database and statistical analysis was performed using SPSS 22.0software.Univariate analysis was performed using chi-square test,rank sum test,or T-test;multivariate analysis was performed using binary logistic regression analysis to identify risk factors and establish a logistic regression equation model.Part II: Through prospective study research methods,a total of 44 cases were included in the Department of Urology,First Affiliated Hospital of Guangzhou University of Chinese Medicine from January 1,2017 to December 31,2017.Thecases were randomly divided into observation group(n=22)and control group(n=22)according to the lottery method.Observation group: Chinese medicine injection + antibiotics;control group: antibiotics.The following indicators were recorded:the highest/lowest body temperature within 72 hours after surgery(to recordlowest body temperature when the body temperature was lower than 36°C)?respiratory rate?heart rate?white blood cell(WBC)counts before surgery?and WBC counts12 hours and 72 hours after surgery.The recorded case data were input into the database,and SPSS 22.0 software was used for statistical analysis,including rank sum test,chi square test or T test,finally get the conclusion.Results1.The results of univariate analysis showed that thestatistically significant(P<0.05)factors as follows: history of fever associated with stones urinary stones?preoperative TCM syndrome?site of stones?maximum diameter of stones?preoperative urine WBC count?preoperative middle urine and renal pelvis urine culture results?preoperative use of antibiotics?surgical methods and length of surgery;2.Multivariate logistic regression analysis showed that thestatistically significant(P<0.05)factorsas follows: history of fever associated with urinary stones?preoperative TCM syndrome?preoperative middle urine and renal pelvis urine culture resultsand site of stones;3.According to the results of binary logistic regression,the regression equation model was derived: postoperativeincidence of SIRS(P)=Exp(-2.623 +1.572*history of fever associated with urinary stones+0.992*preoperative middle urine and renal pelvis urine culture results+1.495*Kidney stones+0.254 *stones in other parts+1.306*bladder stones+0.821*Kidney deficiency type+1.182*hot and damp type)/[1+(-2.623 + 1.572*history of fever associated with urinary stones+0.992*preoperative middle urine and renal pelvis urine culture results+1.495*Kidney stones+ 0.254 *stones in other parts+1.306*bladder stones+0.821*Kidney deficiency type+1.182*hot and damp type)].The overall accuracy of the model is 77.5%;4.The incidence of SIRS in the observation group and control group was9.52% and 38.1%,the difference was statistically significant(P=0.030<0.05).The WBC count of 72 hours after surgery in the observation groupwas significantly lower than in the control group(P=0.005<0.05).Conclusion1.History of fever associated with urinary stones?preoperative TCM syndrome?preoperative middle urine and renal pelvis urine culture resultsand site of stones are the independent risk factors for SIRS after urolithiasis surgery.2.The integrative of Chinese and Western medicine to prevent SIRS after urolithiasis surgery has a significant effect,and can significantly reduce the WBC count 72 hoursafter surgery.