Risk Factors Assessment And Treatment Study Of Flexible Ureteroscopic Lithotripsy Complicated With SIRS

Objective:To collect all the clinical data of stone disease with flexible ureteroscopic lithotripsy(FURL)and creat a useful clinical datebase.To analyze risk factors of patients with FURL postoperative systemic inflammatory response syndrome(SIRS)and establish prediction model of SIRS,reducing the morbidity of SIRS.To evaluate therapeutic effect and the associated risks of continuous renal replacement therapy(CRRT)in stone-related septic shock patients.Materials and Methods:A retrospective collection in September 2012-August 2015,Xinhua Hospital Urology undergoing flexible ureteroscope lithotripsy(FURL)1205 cases of clinical data of patients,including: general data;characterized in stone;history of chronic disease;history of stones surgery;preoperative condition;laboratory examinations;operation;complications;patient contact.Statistical method selected patients who met the inclusion criteria FURL of patients and postoperative SIRS.The retrospective study included 1066 patients with FURL,88 cases SIRS,the control group 978 cases.Statistical methods were used in above database observation to obtain statistically significant outcome measure.Analyze risk factors for postoperative SIRS of FURL by Logistic regression,and creat prediction model.By receiver operating characteristic(ROC)analysis of the sensitivity and specificity of positive predictors and prediction model.Retrospectively collected in July 2013 ~ August 2015 the clinical treatment data of 20 patients with stone-related septic shock in our ICU.CRRT group of 6 cases,13 cases of non-CRRT group,1 patients death in the first day of ICU treatment.Comparative analysis of the two groups of critically ill patients in ICU: 0h,24 h,48h,72 h period: white blood cell(WBC),platelets(PLT),procalcitonin(PCT),creatinine(Cr),blood lactate(LAC)and other indicators.The mean of two groups were compared T test,The overall mean of each time period were compared by one-way ANOVA.Through the analysis of the statistical results combined with clinical knowledge,evaluate therapeutic effect and the associated risks of CRRT in stone-related septic shock patientsResults:The clinical data of FURL patients with 1205 cases: 1079 patients with simple successful F-URL,88 cases(7.30%)complicated by SIRS,13 cases with postoperative fever but did not meet the diagnostic criteria for SIRS,978 cases(81.16%)normal;38 cases failed;25 cases FURL + PCNL,36 cases FURL + URL,the postoperative SIRS case not included in the second part of research;27 cases of mass date deficiencies.FURL postoperative SIRS univariate analysis of female,elderly,congenital kidney abnormalities,bacteriuria,recent urinary tract infection;PCNL history,renal open lithotomy history;signs of infection in operation,general anesthesia;N%> 70%,anemia,urine WBC,CRP,PCT significantly higher.Logsitic analysis of female,bacteriuria,congenital kidney abnormalities,recent urinary tract infection,anemia,renal open lithotomy history,general anesthesia,urine WBC(> 10/HP),N%> 70% difference was statistically significant.ROC of prediction model(AUC = 0.840),congenital renal abnormalities(AUC = 0.520,P = 0.540)and the history of renal open lithotomy(AUC=0.531,P=0.341).The basis situation of 19 cases critically ill patients in the ICU was no significant difference.CRRT group and non-CRRT group outcome measures varied within 72 h comparison: the WBC(P = 0.049),the PCT(P = 0.018),lactic acid(P= 0.007)were significantly different.No significant differences between groups creatinine(P=0.405),but CRRT group creatinine levels decreased rapidly;no significant difference(P= 0.482)between the PLT,CRRT platelet decline.2 patients died in the CRRT group,on average ICU hospitalization time was(14.00 ± 3.10)d,non-CRRT group 3 patients died,on average ICU hospitalization time was(18.16 ± 4.94)d.ConclusionFemale,bacteriuria,congenital kidney abnormalities,the recent urinary tract infections history,anemia,open stone history,general anesthesia,urine WBC(> 10/HP),N%> 70% higher risk of postoperative FURL of SIRS.Regression equation: Logit(P)=-5.161+1.210(female)+1.728(bacteriuria)+1.712(congenital kidney abnormalities)+1.270(urinary tract infection history)+1.373(Open lithotomy)+1.058(urine WBC)+1.091(N%),efficiency of the prediction model is good.Renal congenital anomalies and open lithotomy forecast FURL postoperative SIRS poor sensitivity and specificity.Calculi complicated by septic shock patients with clinical treatment,CRRT is an important adjuvant therapy for a quick way to reduce the level of inflammation in the body,correct water and acid-base balance disorders,the use should still rigorous assessment and monitoring of patients with blood coagulation state.