张志宏+金石华+黄华刚

    [摘要] 目的 分析输尿管软镜碎石术后并发脓毒症的相关因素及临床诊治，探讨其预防和救治措施。方法 回顾性分析2010年11月～2016年12月两个泌尿中心786例输尿管软镜钬激光碎石术患者中25例并发脓毒症者的临床资料，观察住院时间、抗感染治疗时间、临床转归。以上患者术前常规留取尿培养+药物敏感试验，留置双J管7～10 d，术中均按常规剂量静脉应用抗生素，使用OLYMPUS F3.6/9.9输尿管软镜，Power Suite100W钬激光碎石。 结果 患者术前尿培养阳性者16例，手术时间55～175 min，平均(94±11)min；住院时间13～28 d，平均(14.4±1.5)d；术后抗感染治疗3～10 d，平均(4.1±1.5)d。11例患者术后出现严重脓毒症，9例并发脓毒性休克，其中7例转ICU治疗。 结论 脓毒症的防治应把握好术前、术中及术后多个环节，早期发现临床征象并积极针对性地治疗是输尿管软镜术后并发脓毒症救治成功的关键。

    [关键词] 输尿管软镜；脓毒症；碎石术；钬激光

    [中图分类号] R631 [文献标识码] A [文章编号] 1673-7210(2017)08(c)-0085-03

    [Abstract] Objective To analyze the related factors， clinical diagnosis and treatment of postoperative sepsis after flexible ureteroscope lithotripsy and explore its prevention and treatment measures. Methods Clinical data of 25 patients with sepsis in 786 cases of ureteroscopic holmium laser lithotripsy in two urinary centers from November 2010 to December 2016 were retrospectively analyzed. Hospital stay， anti-infection treatment time， clinical outcome were observed. Preoperative conventional urine culture and drug sensitivity test were performed in all the patients. Double J tubes were indwelled for 7-10 days. Intraoperative intravenous antibiotics were routinely applied. OLYMPUS F3.6/9.9 flexible ureteroscope and Power Suite100W holmium laser were used for lithotripsy. Results 16 cases showed positive results of preoperative urine culture ......