【摘要】 目的 探討微創(chuàng)經(jīng)皮腎鏡碎石術(shù)后并發(fā)感染性休克的原因和防治措施。 方法 回顧性分析2005年1月-2010年12月5例經(jīng)皮腎鏡術(shù)300例，其中術(shù)后并發(fā)感染性休克5例的臨床資料。男1例，女4例，均表現(xiàn)為術(shù)后2~8 h內(nèi)出現(xiàn)寒戰(zhàn)、高熱、煩燥不安，血壓降至80/50 mm Hg（1 mm Hg=0.133 kPa）以下，心率超過(guò)120次/min。所有患者均行抗感染和抗休克治療。 結(jié)果 所有患者均在72 h內(nèi)停用升壓藥，1周內(nèi)體溫及血常規(guī)恢復(fù)正常，術(shù)后15 d治愈出院。 結(jié)論 感染性休克是微創(chuàng)經(jīng)皮腎鏡碎石術(shù)嚴(yán)重的并發(fā)癥之一，術(shù)前有效抗感染、術(shù)中低壓灌注、術(shù)后加強(qiáng)生命體征的監(jiān)測(cè)、早期發(fā)現(xiàn)并合理處理，可有效防治感染性休克的發(fā)生。
【Abstract】 Objective To explore the etiology and treatment of septic shock after percutaneous nephrolithotomy. Methods From Janurary 2005 to December 2010, the clinical data of five patients with septic shock after percutaneous nephrolithotomy in our hospital were retrospectively analyzed. The patients, including one male and four females, had chillness and high temperature after the nephrolithotomy. The blood pressure decreased to under 80/50 mm Hg （1 mm Hg=0.133 kPa）, and the heart rate was more than 120 per minute. All patients underwent anti-shock and anti-infection therapies rapidly. Results Five patients were cured in the end, their temperature and blood routine tests returned to normal within one week. Conclusions Septic shock is one of the serious complications after percutaneous nephrolithotomy. Effective preoperative preparation, low pressure irrigation during operation, early diagnosis and treatment postoperatively are the effective ways to prevent the septic shock.
引用本文： 程樹(shù)林,朱平宇,陳雙全,廖波,李建勇. 經(jīng)皮腎鏡碎石術(shù)后并發(fā)感染性休克的診治. 華西醫(yī)學(xué), 2011, 26(9): 1348-1350. doi: 復(fù)制
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| 2. | 張建華, 官潤(rùn)云, 龍江, 等. 上尿路腔內(nèi)碎石術(shù)后并發(fā)感染性休克的處理和預(yù)防[J]. 臨床泌尿外科雜志, 2009, 24(3): 171-172. |
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| 4. | 向松濤, 王樹(shù)聲, 甘澍, 等. 經(jīng)皮腎鏡取石術(shù)后尿膿毒癥休克的診治特點(diǎn)分析[J]. 中華泌尿外科雜志, 2010, 31(8): 520-523. |
| 5. | Michel MS, Trojan L, Rassweiler JJ. Complications in percutaneous nephrolithotomy[J]. Eur Urol, 2007, 51(4): 899-906. |
| 6. | O’Keeffe NK, Mortimer AJ, Sambrook PA, et al. Severe sepsis following percutaneous or endoscopic procedures for urinary tract stones[J]. Br J Urol, 1993, 72(3): 277-283. |
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| 8. | Oka T, Hara T, Miyake O, et al. A study on bacteria within stones in urolithiasis[J]. Hinyokika Kiyo, 1989, 35(9): 1469-1474. |
| 9. | Sihler KC, Nathens AB. Management of severe sepsis in the surgical patient[J]. Surg Clin North Am, 2006, 86(6): 1457-1481. |
| 10. | Nguyen HB, Rivers EP, Abrahamian FM, et al. Severe sepsis and septic shock: review of the literature and emergency department management guidelines[J]. Ann Emerg Med, 2006, 48(1): 28-54. |
| 11. | Dell I, Nger RP, Levy MM, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2008[J]. Intensive Care Med, 2008, 34(1): 17-60. |
| 12. | Zanetti G, Paparella S, Trinchieri A, et al. Infections and urolithiasis:current clinical evidence in prophylaxis and antibiotic therapy[J]. Arch Ital Urol Androl, 2008, 80(1): 5-12. |
| 13. | Nguyen LH, Hsu DI, Ganapathy V, et al. Reducing empirical useof fluoroquinolones for Pseudomonas aeruginosa infections improves outcome[J]. J Antimicrob Chemother, 2008, 61(3): 714-720. |
- 1. Skolarikos A, Alivizatos G, de la Rosette JJ. Percutaneous nephrolithotomy and its legacy[J]. Eur Urol, 2005, 47(1): 22-28.
- 2. 張建華, 官潤(rùn)云, 龍江, 等. 上尿路腔內(nèi)碎石術(shù)后并發(fā)感染性休克的處理和預(yù)防[J]. 臨床泌尿外科雜志, 2009, 24(3): 171-172.
- 3. 張華, 高小峰, 周鐵, 等. 經(jīng)皮腎鏡術(shù)后并發(fā)感染性休克一例報(bào)告并文獻(xiàn)復(fù)習(xí)[J]. 中華腔鏡泌尿外科雜志（電子版）, 2009, 3(3): 243-244.
- 4. 向松濤, 王樹(shù)聲, 甘澍, 等. 經(jīng)皮腎鏡取石術(shù)后尿膿毒癥休克的診治特點(diǎn)分析[J]. 中華泌尿外科雜志, 2010, 31(8): 520-523.
- 5. Michel MS, Trojan L, Rassweiler JJ. Complications in percutaneous nephrolithotomy[J]. Eur Urol, 2007, 51(4): 899-906.
- 6. O’Keeffe NK, Mortimer AJ, Sambrook PA, et al. Severe sepsis following percutaneous or endoscopic procedures for urinary tract stones[J]. Br J Urol, 1993, 72(3): 277-283.
- 7. Tenke P, Kovacs B, Jackel M. The role of biofilm infection in urology[J]. World J Urol, 2006, 24(1): 13-20.
- 8. Oka T, Hara T, Miyake O, et al. A study on bacteria within stones in urolithiasis[J]. Hinyokika Kiyo, 1989, 35(9): 1469-1474.
- 9. Sihler KC, Nathens AB. Management of severe sepsis in the surgical patient[J]. Surg Clin North Am, 2006, 86(6): 1457-1481.
- 10. Nguyen HB, Rivers EP, Abrahamian FM, et al. Severe sepsis and septic shock: review of the literature and emergency department management guidelines[J]. Ann Emerg Med, 2006, 48(1): 28-54.
- 11. Dell I, Nger RP, Levy MM, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2008[J]. Intensive Care Med, 2008, 34(1): 17-60.
- 12. Zanetti G, Paparella S, Trinchieri A, et al. Infections and urolithiasis:current clinical evidence in prophylaxis and antibiotic therapy[J]. Arch Ital Urol Androl, 2008, 80(1): 5-12.
- 13. Nguyen LH, Hsu DI, Ganapathy V, et al. Reducing empirical useof fluoroquinolones for Pseudomonas aeruginosa infections improves outcome[J]. J Antimicrob Chemother, 2008, 61(3): 714-720.