结石梗阻致尿源性脓毒血症的影响因素及早期诊治策略分析

何问理?温海东?罗云

【摘要】目的 分析結石梗阻致尿源性脓毒血症的相关因素，探讨早期诊治策略。方法 收集72例结石梗阻致尿源性脓毒血症患者（脓毒血症组）及50例结石梗阻未并发脓毒血症患者（结石梗阻组）的病历资料，记录年龄、性别、BMI、结石疼痛时间、合并症、血尿真菌/细菌培养结果、结石类型等资料，比较组间差异，并采用多因素Logistic回归分析结石梗阻致尿源性脓毒血症的影响因素。结果 与结石梗阻组相比，脓毒血症组女性患者、年龄≥60岁者、肥胖（BMI≥28 kg/m2） 者、结石疼痛≥72 h者、合并糖尿病或肾功能不全者、尿真菌/细菌培养阳性者、输尿管结石者比例均较高（P均< 0.05）。以是否发生尿源性脓毒血症为自变量，多因素Logistic 回归分析显示女性、年龄≥60岁、肥胖、合并糖尿病、合并肾功能不全、尿真菌/细菌培养阳性、血真菌/细菌培养阳性、输尿管结石均为结石梗阻致尿源性脓毒血症的影响因素（P均< 0.05）。结论 年龄、性别、基础疾病等均为结石梗阻致尿源性脓毒血症的相关危险因素，临床对该类患者应保持高度的警惕，及早进行干预，以降低尿源性脓毒血症的发生风险。

【关键词】结石梗阻;尿源性脓毒血症;危险因素;诊治策略

Analysis of influencing factors， early diagnosis and treatment strategies of urinary sepsis caused by stone obstruction He Wenli， Wen Haidong， Luo Yun. Department of Urology， the Third Affiliated Hospital of Sun Yat-sen University， Yuedong Hospital， Meizhou 514021， China

Corresponding author， Wen Haidong

【Abstract】Objective To analyze the influencing factors of urinary sepsis caused by stone obstruction and to explore the early diagnosis and treatment strategies. Methods Clinical data of 72 patients with urinary sepsis induced by stone obstruction （urinary sepsis group） and 50 patients with stone obstruction alone （stone obstruction group） were retrospectively analyzed. Medical record of all patients was collected. Age， sex， body mass index （BMI）， time of stone pain， complications， urine culture outcomes for fungus/bacteria and type of stones were recorded and statistically compared between two groups. The influencing factors of urinary sepsis induced by stone obstruction were analyzed by logistic regression analysis. Results Compared with the stone obstruction group， the proportion of female patients， those aged≥60 years， obesity （BMI≥28 kg/m2）， those with stone pain≥72 h， those complicated with diabetes mellitus or renal insufficiency， those positive for fungus/bacteria in urine culture， and those with ureteral stones was significantly higher compared with that in the urinary sepsis group （all P < 0.05）. Whether urinary sepsis occurred was regarded as an independent variable. Multivariate logistic regression analysis demonstrated that female， age≥60 years， obesity， complicated with diabetes mellitus or renal insufficiency， positive urine culture for fungus/bacteria， positive blood culture for fungus/bacteria and ureteral stones were the influencing factors of urinary sepsis caused by stone obstruction （all P < 0.05）. Conclusions Age， sex and basic diseases are the influencing factors of urinary sepsis induced by stone obstruction. Extensive attention and early intervention should be delivered to these patients， aiming to reduce the risk of urinary sepsis caused by stone obstruction.

【Key words】Stone obstruction;Urinary sepsis;Risk factor;Diagnosis and treatment strategy

尿源性脓毒血症是由泌尿系统感染引起的全身性感染性疾病，起病急、发展迅速、病死率高，已越来越被人们所重视[1-2]。研究显示，尿源性脓毒血症患者多伴泌尿系统的梗阻，其中尿路结石为尿路梗阻最常见原因之一[3-4]。目前，对尿源性脓毒血症的研究集中在经输尿管镜、经皮肾镜等有创操作及治疗，对初诊即出现结石梗阻导致的尿源性脓毒血症研究鲜有报道。结石梗阻所致尿路感染患者早期以发热、腰痛等症状为主要表现，缺乏诊断特异性，一旦发展至脓毒血症，将为临床治疗带来极大的难度[5]。为此，本研究以结石梗阻致尿源性脓毒血症患者为研究对象，分析其影响因素，旨在为尿源性脓毒血症的临床防治提供参考，现报告如下。

对象与方法