尿脓毒血症非休克组与休克组的临床特征比较
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摘要
目的探讨尿脓毒血症的临床特征及变化,为尿脓毒血症的诊疗提供思路及参考。方法回顾2015年1月1日至2018年1月1日昆明医科大学第一附属医院泌尿外科诊断为脓毒血症或感染性休克(脓毒性休克)的患者,对其临床信息进行分析。根据诊断分为尿脓毒血症非休克组和尿脓毒血症休克组,对其临床基本特征及合并疾病、病原菌、辅助检查指标等进行分析。结果(1)尿脓毒血症休克组合并高血压和肺部疾病的几率高于非休克组,其差异具有统计学意义(P<0.05);(2)尿脓毒血症的病原菌以革兰阴性菌为主,血培养及尿培养阳性率在非休克与休克组的差异无统计学意义(P>0.05);(3)血白细胞在两组中均升高,但在休克组及非休克组的差异无统计学意义(P>0.05);(4)血小板计数休克组低于非休克组,差异有统计学意义(P<0.05);(5)C-反应蛋白、降钙素原、乳酸在非休克组与休克组中均升高,且三者在休克组中的值高于非休克组,差异具有统计学意义(P<0.05)。结论尿脓毒血症病原菌以革兰氏阴性菌为主,合并高血压、肺部疾病是尿脓毒血症发展为感染性休克的危险因素,血小板、C-反应蛋白、降钙素原及乳酸值是可以预测尿脓毒血症是否发展为感染性休克的重要指标。
Objective To analyze the clinical characteristics of urinary sepsis so as to provide reference for the early diagnosis and treatment of this disease.Methods The clinical data of 62 patients with urinary sepsis treated during Jan.2015 and Jan.2018 were retrospectively analyzed.According to the diagnostic criteria,the patients were classified into 2 groups:40 in the non-shock group,and 22 in the shock group.The clinical characteristics,complications,pathogenic bacteria,and other parameters were compared between the two groups.Results The shock group were more likely to be complicated with hypertension and lung diseases than the non-shock group(P<0.05).Gram-negative bacteria were the main pathogenic bacteria of urinary sepsis,and the positive rates of blood culture and urine culture were not statistically different between the non-shock and shock groups(P>0.05).Leukocyte count increased in both groups,and there was no significant difference(P>0.05).Platelet count decreased in both groups,and the shock group had a greater decrease than the non-shock group(P<0.05).C-reactive protein,procalcitonin and lactic acid increased in both groups,and the shock group had a greater increase than the non-shock group(P<0.05).Conclusion Gram-negative bacteria were the main pathogenic bacteria of urinary sepsis.Concomitant hypertension or pulmonary disease are the risk factors of septic shock.Platelet count,c-reactive protein,procalcitonin and lactic acid values are important indicators for the prognosis of urinary sepsis.
Objective To analyze the clinical characteristics of urinary sepsis so as to provide reference for the early diagnosis and treatment of this disease.Methods The clinical data of 62 patients with urinary sepsis treated during Jan.2015 and Jan.2018 were retrospectively analyzed.According to the diagnostic criteria,the patients were classified into 2 groups:40 in the non-shock group,and 22 in the shock group.The clinical characteristics,complications,pathogenic bacteria,and other parameters were compared between the two groups.Results The shock group were more likely to be complicated with hypertension and lung diseases than the non-shock group(P<0.05).Gram-negative bacteria were the main pathogenic bacteria of urinary sepsis,and the positive rates of blood culture and urine culture were not statistically different between the non-shock and shock groups(P>0.05).Leukocyte count increased in both groups,and there was no significant difference(P>0.05).Platelet count decreased in both groups,and the shock group had a greater decrease than the non-shock group(P<0.05).C-reactive protein,procalcitonin and lactic acid increased in both groups,and the shock group had a greater increase than the non-shock group(P<0.05).Conclusion Gram-negative bacteria were the main pathogenic bacteria of urinary sepsis.Concomitant hypertension or pulmonary disease are the risk factors of septic shock.Platelet count,c-reactive protein,procalcitonin and lactic acid values are important indicators for the prognosis of urinary sepsis.
引文
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[15]邵伟雄,王江.血小板参数在脓毒血症疗效观察中的应用[J].中国医药指南,2012,10(30):511.
[16]KAMEI J,NISHIMATSU H,NAKAGAWA T,et al.Risk factors for septic shock in acute obstructive pyelonephritis requiring emergency drainage of the upper urinary tract[J].Int Urol Nephrol,2014,46(3):493-497.
[17]LYU X,XU Q,CAI G,et al,Efficacies of fluid resuscitation as guided by lactate clearance rate and central venous oxygen saturation in patients with septic shock[J].Zhonghua Yi Xue Za Zhi,2015,17;95(7):496-500.
[18]SUISTOMMA M,RUOKONEN E,KARI A,et al.Time-pattern of lactate and lactate to pyruvate ratio in the first 24hours of intensive care emergency admissions[J].Shock,2000,14(1):8-12.
[2]TEFEKLI A,ESEN T,OLBERT PJ,et al.Isolated upper pole access in percutaneous nephrolitholomy:a large-scale analysis from the CROES percutaneous nephrolitholomy global study[J].J Urol,2013,189(2):568-573
[3]MARTIN GS,MANNINO DM,EATON S,et al.The epidemiology of sepsis in the United States from 1979through 2000[J].N Engl J Med,2003,348(16);1546-1554
[4]BRUN-BUISSON C,MESHAKA P,PINTON P,et al.EPISEPSIS:a reappraisal of the epidemiology and outcome of severe sepsis in French intensive care units[J].Intensive Care Med,2004,30(4):580-588.
[5]YOSHIMURA K,UTSUNOMIYA N,ICHIOKA K,et al.Emergency drain-age for urosepsis associated with upper urinary tract calculi[J].J Urol,2005,173(2):458-462.
[6]LEE JH,LEE YM,CHO JH.Risk factors of septic shock in bactere-mic acute pyelonephritis patients admitted to an ER[J].J Infect Chemother,2012,18(1):130-133.
[7]PARK IH,LEC SH,YU ST,et al.Serum procalcitonin as a digangnostic marker of neonatal sepsis[J].Korean J Pediatr,2014,57(10):451-456.
[8]王宝海,侯海峰,刘川,等.血清降钙素原在诊断尿脓毒血症中的意义[J].重庆医科大学学报,2014,39(6):812-815.
[9]PEDUZZI P,SHATNEY C,SHEAGREN J,et al.Predictors of bacteremia and gram-negative bacteremia in patients with sepsis.The Veterans Affairs Systemic Sepsis Cooperative Study Group[J].Arch Intern Med,1992,152(3):529-535.
[10]张江兵.尿源性脓毒血症早期血白细胞下降机理的初步研究[D].浙江大学,2016:1-40.
[11]LI HX,LIU ZM,ZHAO SJ,et al.Measuring both procalcitonin and C-reactive protein for a diagnosis of sepsis in critically ill patient[J].J Int Med Res,2014,42(4):1050-1059.
[12]ALBANOPOULOS K,ALEVIZOS L,NATOUDI M,et al.C-reactive protein,white blood cells,and neutrophils as early predictors of postopera-tive complications in patients undergoing laparoscopic sleeve gas-trectomy[J].Surg Endosc,2013,27(3):864-871.
[13]BERGER I,WILDHOFEN S,LEE A,et al.Emergency nephrectomy due to severe urosepsis:a retrospective,multicentre analysis of 65cases[J].BJU Int,2009,104(3):386-390.
[14]高红梅,王兵,李寅,等.重组人血小板生成素治疗脓毒症血小板减少症[J].中华急诊医学杂志,2011,20(3):239-243.
[15]邵伟雄,王江.血小板参数在脓毒血症疗效观察中的应用[J].中国医药指南,2012,10(30):511.
[16]KAMEI J,NISHIMATSU H,NAKAGAWA T,et al.Risk factors for septic shock in acute obstructive pyelonephritis requiring emergency drainage of the upper urinary tract[J].Int Urol Nephrol,2014,46(3):493-497.
[17]LYU X,XU Q,CAI G,et al,Efficacies of fluid resuscitation as guided by lactate clearance rate and central venous oxygen saturation in patients with septic shock[J].Zhonghua Yi Xue Za Zhi,2015,17;95(7):496-500.
[18]SUISTOMMA M,RUOKONEN E,KARI A,et al.Time-pattern of lactate and lactate to pyruvate ratio in the first 24hours of intensive care emergency admissions[J].Shock,2000,14(1):8-12.