• 川北醫(yī)學院附屬醫(yī)院泌尿外科（四川南充，637000）;

【摘要】　目的　 探討微創(chuàng)經皮腎鏡碎石術后并發(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例經皮腎鏡術300例，其中術后并發(fā)感染性休克5例的臨床資料。男1例，女4例，均表現(xiàn)為術后2~8 h內出現(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120次/min。所有患者均行抗感染和抗休克治療。　結果　 所有患者均在72 h內停用升壓藥，1周內體溫及血常規(guī)恢復正常，術后15 d治愈出院。　結論　 感染性休克是微創(chuàng)經皮腎鏡碎石術嚴重的并發(fā)癥之一，術前有效抗感染、術中低壓灌注、術后加強生命體征的監(jiān)測、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： 程樹林,朱平宇,陳雙全,廖波,李建勇. 經皮腎鏡碎石術后并發(fā)感染性休克的診治. 華西醫(yī)學, 2011, 26(9): 1348-1350. doi: 復制

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  1. 1. 　Skolarikos A, Alivizatos G, de la Rosette JJ. Percutaneous nephrolithotomy and its legacy[J]. Eur Urol, 2005, 47(1): 22-28.
  2. 2. 　張建華, 官潤云, 龍江, 等. 上尿路腔內碎石術后并發(fā)感染性休克的處理和預防[J]. 臨床泌尿外科雜志, 2009, 24(3): 171-172.
  3. 3. 　張華, 高小峰, 周鐵, 等. 經皮腎鏡術后并發(fā)感染性休克一例報告并文獻復習[J]. 中華腔鏡泌尿外科雜志（電子版）, 2009, 3(3): 243-244.
  4. 4. 　向松濤, 王樹聲, 甘澍, 等. 經皮腎鏡取石術后尿膿毒癥休克的診治特點分析[J]. 中華泌尿外科雜志, 2010, 31(8): 520-523.
  5. 5. 　Michel MS, Trojan L, Rassweiler JJ. Complications in percutaneous nephrolithotomy[J]. Eur Urol, 2007, 51(4): 899-906.
  6. 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. 7. 　Tenke P, Kovacs B, Jackel M. The role of biofilm infection in urology[J]. World J Urol, 2006, 24(1): 13-20.
  8. 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. 9. 　Sihler KC, Nathens AB. Management of severe sepsis in the surgical patient[J]. Surg Clin North Am, 2006, 86(6): 1457-1481.
  10. 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. 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. 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. 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.