尿路结石所致梗阻型急性肾盂肾炎脓毒症的危险因素分析

摘要

Objective To explore the risk factors of obstructive acute pyelonephritis caused by urinary calculi. Method 80 cases of sepsis patients receiving treatment in our hospital between Jan. 2007 and Dec. 2012 were collected and reviewed. According to the clinical characteristics of patients were divided into non-obstructive acute pyelonephritis caused by urinary calculi group (group A, n=40) and obstructive acute pyelonephritis caused by urinary calculi group (group B, n=40). The general situation of patients and the results of laboratory tests were recorded in detail. Non conditional Logistic regression analysis of risk factors for obstructive acute pyelonephritis caused by urinary calculi by single and multiple factors. Result 80 cases of sepsis in patients with clinical features, group B in the MAP score, SOFA score, APACHE II score, SAPS score, SCr score, blood lactate score, 24 h liquid net score, heart rate, blood BUN, PCT were significantly higher than that of group A (P<0.05), 24h in urine, oxygenation index, albumin, platelet, blood sodium were significantly lower than group A (P<0.05). The high MAP score, high SAPS score, high SCr score, high score, high arterial blood lactate 24 h liquid net score, heart rate, thrombocytopenia, low blood sodium levels could increase the risk of obstructive acute pyelonephritis caused by urinary calculi (OR=0.825-2.013, P<0.05). Conclusion Clinicians in the diagnosis and treatment of obstructive acute pyelonephritis caused by urinary calculi, more attention should be given to patients with MAP score, SAPS score, SCr score, blood lactate score, 24 h net amount of liquid score, heart rate, blood platelet and blood sodium level.%目的 探讨尿路结石所致梗阻型急性肾盂肾炎脓毒症的相关危险因素.方法 选择2007年1月至2012年12月在本院接受治疗的脓毒症患者80例,根据患者临床特征分为非尿路结石所致梗阻型急性肾盂肾炎脓毒症组(A组,n=40)和尿路结石所致梗阻型急性肾盂肾炎脓毒症组(B组,n=40).详细记录患者的一般情况和实验室检查结果,应用单因素、多因素非条件Logistic回归分析进行尿路结石所致梗阻型急性肾盂肾炎脓毒症的危险因素分析.结果 80例脓毒症患者的临床特征分析显示,B组的平均动脉压(MAP)评分、序贯器官衰竭评分(SOFA)、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、简化急性生理评分(SAPS)、血肌酐(SCr)评分、动脉血乳酸评分、24小时液体净入量评分、血尿素氮(BUN)、心率、降钙素原(PCT)显著高于A组(P<0.05),而24小时尿量、氧合指数、白蛋白、血小板、血钠水平显著低于A组(P<0.05).多因素非条件Logistic回归分析显示,MAP评分、SAPS评分、SCr评分、动脉血乳酸评分、24小时液体净入量评分升高及心率加快、血小板减少、血钠水平降低均会增加尿路结石所致梗阻型急性肾盂肾炎脓毒症的发生风险(OR=0.825~2.013,P<0.05).结论 临床医师在诊治尿路结石所致梗阻型急性肾盂肾炎脓毒症的过程中,应更关注患者的MAP评分、SAPS评分、SCr评分、动脉血乳酸评分、24小时液体净入量评分、心率、血小板及血钠水平.