袁小旭?叶啸?邓健?谢群?庞国福

【摘要】目的 探討经皮肾造瘘术治疗输尿管梗阻继发的尿源性脓毒血症的全因死亡危险因素。方法 回顾性分析164例经皮肾造瘘术治疗输尿管梗阻继发的尿源性脓毒血症患者的临床资料，进行入院到出院后30 d内的死亡危险因素分析，当变量在单因素分析中有统计学意义时，采用多因素Logistic回归分析。结果 164例中11例（6.7%）在住院期间或出院后30 d内死亡。与幸存组患者比较，死亡组患者在ICU时间更长，淋巴细胞数更低，碱性磷酸酶、直接胆红素、总胆红素和血浆渗透压均更高（P均< 0.05）。肾积水面积以及经皮肾造瘘术当日、术后第2日的序贯器官衰竭估计评分（SOFA）和术后第2日SOFA升高值与病死率相关（P均< 0.05）。术后呼吸频率更快、快速SOFA更高的患者病死率更高（P均< 0.05）。PCN前后呼吸频率变化、精神状态变化和快速SOFA变化与病死率相关（P均< 0.05）。多因素Logistic回归分析显示，经皮肾造瘘术后第2日的SOFA与死亡率相关（P = 0.001）。结论 对于经皮肾造瘘术治疗的输尿管梗阻继发尿源性脓毒血症患者，术后第2日的SOFA是其入院到出院30 d内全因死亡的最重要的危险因素。

【关键词】死亡危险因素;尿源性脓毒血症;输尿管梗阻;经皮肾造瘘术

Risk factors of mortality in patients with urosepsis secondary to ureteral obstruction manipulated by percutaneous nephrostomy Yuan Xiaoxu， Ye Xiao， Deng Jian， Xie Qun， Pang Guofu. Department of Urology， Zhuhai Peoples Hospital， Zhuhai 519000， China

Corresponding author， Pang Guofu， E-mail： pangguofu010919@ 163. com

【Abstract】Objective To explore the significant risk factors associated with the all-cause mortality in patients with urosepsis secondary to ureteral obstruction manipulated by percutaneous nephrostomy.Methods Clinical data of 164 patients with urosepsis secondary to ureteral obstruction undergoing percutaneous nephrostomy were retrospectively analyzed. The risk factors of mortality rate before admission and within 30 d after discharge were analyzed. The significant variables identified by univariate analysis were subject to multivariate Logistic regression analysis. Results Eleven （6.7%） of 164 patients with urosepsis secondary to ureteral obstruction manipulated by percutaneous nephrostomy died during hospitalization or within 30 d after discharge. The mortality rate of patients with longer length of ICU stay was significantly increased （P = 0.001）. Patients with higher mortality rate presented with lower lymphocyte count， alkaline phosphatase， direct bilirubin， higher total bilirubin and Plasma osmolality（all P < 0.05）. Hydronephrosis， sequential organ failure assessment （SOFA） scores on the day of percutaneous nephrostomy and postoperative 2 d and the increase in SOFA score at 2 d after percutaneous nephrostomy were significantly correlated with the mortality rate （all P < 0.05）. Patients with higher respiration rate and quick SOFA （qSOFA） score after percutaneous nephrostomy showed higher mortality rate （both P < 0.05）. The changes of respiration rate before and after percutaneous nephrostomy， mental status and the changes of qSOFA scores before and after percutaneous nephrostomy were significantly correlated with the mortality rate （all P < 0.05）. Multivariate Logistic regression analysis showed that SOFA score at 2 d after percutaneous nephrostomy was significantly associated with the mortality rate （P = 0.001）. Conclusion SOFA score at 2 d after percutaneous nephrostomy is the most significant risk factor of the all-cause mortality rate in patients with urosepsis secondary to ureteral obstruction undergoing percutaneous nephrostomy.

【Key words】Risk factor of mortality;Urosepsis;Ureteral obstruction;Percutaneous

尿源性脓毒血症是由泌尿生殖道感染引起的脓毒血症。尽管与过去相比，尿源性脓毒血症的病死率有所降低，但尿源性脓毒血症仍然是院内死亡的重要原因之一，住院病死率为2% ～ 33%[1-8]。

大多数尿源性脓毒血症继发于输尿管梗阻，除了输尿管内支架置入，经皮肾造瘘术（PCN）也是解除梗阻的方法之一。本研究组探讨了PCN治疗输尿管梗阻继发的尿源性脓毒血症患者的死亡危险因素。

对象与方法

一、研究对象

回顾性分析珠海市人民医院2015年1月至2020年12月收治的164例行PCN解除梗阻继发尿源性脓毒症的患者的资料，将其分为死亡组与幸存组。根据国际公认的第3版脓毒症和脓毒症休克的定义，将尿源性脓毒血症定义为尿路感染和序贯器官衰竭估计评分（SOFA）≥2。本研究获得珠海市人民医院医学伦理委员会的批准（LW-2020-15）。……