Diagnosis and Treatment of Septic Shock after Percutaneous Nephrolithotomy_West China Medical Journal

Authors：

CHENG Shulin , ZHU Pingyu , CHEN Shuangquan , LIAO Bo ,  LI Jianyong

Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P. R. China;

Corresponding author：

LI Jianyong, Email: huaxi2002@163.com

Keywords：

微创经皮肾镜; 感染性休克; 上尿路结石

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【摘要】　目的　探讨微创经皮肾镜碎石术后并发感染性休克的原因和防治措施。　方法　回顾性分析2005年1月-2010年12月5例经皮肾镜术300例，其中术后并发感染性休克5例的临床资料。男1例，女4例，均表现为术后2~8 h内出现寒战、高热、烦燥不安，血压降至80/50 mm Hg（1 mm Hg=0.133 kPa）以下，心率超过120次/min。所有患者均行抗感染和抗休克治疗。　结果　所有患者均在72 h内停用升压药，1周内体温及血常规恢复正常，术后15 d治愈出院。　结论　感染性休克是微创经皮肾镜碎石术严重的并发症之一，术前有效抗感染、术中低压灌注、术后加强生命体征的监测、早期发现并合理处理，可有效防治感染性休克的发生。
【Abstract】　Objective　 To explore the etiology and treatment of septic shock after percutaneous nephrolithotomy. 　Methods　 From Janurary 2005 to December 2010, the clinical data of five patients with septic shock after percutaneous nephrolithotomy in our hospital were retrospectively analyzed. The patients, including one male and four females, had chillness and high temperature after the nephrolithotomy. The blood pressure decreased to under 80/50 mm Hg （1 mm Hg=0.133 kPa）, and the heart rate was more than 120 per minute. All patients underwent anti-shock and anti-infection therapies rapidly.　Results　 Five patients were cured in the end, their temperature and blood routine tests returned to normal within one week.　Conclusions　 Septic shock is one of the serious complications after percutaneous nephrolithotomy. Effective preoperative preparation, low pressure irrigation during operation, early diagnosis and treatment postoperatively are the effective ways to prevent the septic shock.

Citation： CHENG Shulin,ZHU Pingyu,CHEN Shuangquan,LIAO Bo,LI Jianyong. Diagnosis and Treatment of Septic Shock after Percutaneous Nephrolithotomy. West China Medical Journal, 2011, 26(9): 1348-1350. doi: Copy

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1. 　Skolarikos A, Alivizatos G, de la Rosette JJ. Percutaneous nephrolithotomy and its legacy[J]. Eur Urol, 2005, 47(1): 22-28.
2. 　张建华, 官润云, 龙江, 等. 上尿路腔内碎石术后并发感染性休克的处理和预防[J]. 临床泌尿外科杂志, 2009, 24(3): 171-172.
3. 　张华, 高小峰, 周铁, 等. 经皮肾镜术后并发感染性休克一例报告并文献复习[J]. 中华腔镜泌尿外科杂志（电子版）, 2009, 3(3): 243-244.
4. 　向松涛, 王树声, 甘澍, 等. 经皮肾镜取石术后尿脓毒症休克的诊治特点分析[J]. 中华泌尿外科杂志, 2010, 31(8): 520-523.
5. 　Michel MS, Trojan L, Rassweiler JJ. Complications in percutaneous nephrolithotomy[J]. Eur Urol, 2007, 51(4): 899-906.
6. 　O’Keeffe NK, Mortimer AJ, Sambrook PA, et al. Severe sepsis following percutaneous or endoscopic procedures for urinary tract stones[J]. Br J Urol, 1993, 72(3): 277-283.
7. 　Tenke P, Kovacs B, Jackel M. The role of biofilm infection in urology[J]. World J Urol, 2006, 24(1): 13-20.
8. 　Oka T, Hara T, Miyake O, et al. A study on bacteria within stones in urolithiasis[J]. Hinyokika Kiyo, 1989, 35(9): 1469-1474.
9. 　Sihler KC, Nathens AB. Management of severe sepsis in the surgical patient[J]. Surg Clin North Am, 2006, 86(6): 1457-1481.
10. 　Nguyen HB, Rivers EP, Abrahamian FM, et al. Severe sepsis and septic shock: review of the literature and emergency department management guidelines[J]. Ann Emerg Med, 2006, 48(1): 28-54.
11. 　Dell I, Nger RP, Levy MM, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2008[J]. Intensive Care Med, 2008, 34(1): 17-60.
12. 　Zanetti G, Paparella S, Trinchieri A, et al. Infections and urolithiasis:current clinical evidence in prophylaxis and antibiotic therapy[J]. Arch Ital Urol Androl, 2008, 80(1): 5-12.
13. 　Nguyen LH, Hsu DI, Ganapathy V, et al. Reducing empirical useof fluoroquinolones for Pseudomonas aeruginosa infections improves outcome[J]. J Antimicrob Chemother, 2008, 61(3): 714-720.

West China Medical Journal

Diagnosis and Treatment of Septic Shock after Percutaneous Nephrolithotomy

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