微通道经皮肾镜碎石术后并发感染性休克1例报告并文献复习

摘要

[Summary] A 59-year-old woman was reported with calculi in both kidneys and mild hydronephrosis in the right kidney . Bacterial culture was positive from urine samples .After she was given antibiotics therapy , a mini-percutaneous nephrolithotomy was performed.The operation time was 100 min.Septic shock developed after the procedure , manifested as hypotension at 6 hours after surgery, low oxygen saturation , and needing mechanical ventilation . After norepinephrine administration , sensitive antibiotic treatment, and mechanical ventilation , the patient's condition was markedly improved and discharged . In conclusion, mini-percutaneous nephrolithotomy should be avoided in patients with large and complex stones or long operation time expectation .In case of septic shock , it is necessary for intensive care and multidisciplinary collaboration including urology and anti -infectious diseases .%本文报道1例59岁右肾结石合并轻度积水女性患者，术前尿培养结果阳性，给予抗感染治疗后，行右侧微通道经皮肾镜碎石术（ minimally invasive percutaneous nephrolithotomy ， MPCNL），术中过程顺利，术后出现感染性休克表现：开始表现血氧饱和度低，不能脱离呼吸机，术后6h出现血压下降，给予去甲肾上腺素泵入，更换抗生素，持续呼吸机辅助呼吸等治疗后患者治愈出院。我们认为对于结石较大、复杂，预计手术时间长的患者，尽量避免选用微通道；处理MPCNL术后并发感染性休克，重症监护、抗感染科、泌尿外科在内的多学科协作是必要的。