经皮肾镜碎石术后发热相关因素的研究进展

经皮肾镜碎石术（PCNL）已成为处理复杂上尿路结石最常用的手术方式之一。尽管术前可以预防性使用广谱抗菌素，但严重尿路感染、发热仍是PCNL术后常见并发症。虽然PCNL术后发热常能较快消退，在一些患者中仍可发生严重并发症。PCNL术后发热或者严重的尿路感染可增加患者死亡率、住院时间及医疗成本，因此，越来越多的医生开始关注可能导致PCNL术后发热的相关因素。本文主要综述了PCNL术后发热的可能机制及明确术前及术中可能导致PCNL术后发热的相关因素。根据近年国内外数据、文献可以得出，可能影响PCNL术后发热的因素包括糖尿病、术前肾造瘘管的使用、结石成分及形状、肾盂积脓、手术时间及灌注液量，术前尿路感染的适当治疗虽然不能阻止术后炎性反应或发热，但可以降低细菌感染率及促进从全身炎症反应综合征（SIRS）中的恢复。术前尿培养、结石细菌培养及肾盂尿培养均为术后发热的预测因子，能够为术后发热的抗菌素选择提供重要依据。

Research Progress of Factors Affecting Fever Following Percutaneous Nephrolithotomy

Percutaneous nephrolithotomy （PCNL） is one of the most popular methods of removing complicated upper urinary calculus. Despite of prophylactic use of wide-spectrum antibiotics, fever and serious bacteremia are still the most common complications. Although fever after PCNL usually resolves quickly, a more serious course can occur in some patients. Fever or serious urinary tract infections after PCNL increase mortality, hospital duration, and healthcare costs. As a result, more and more doctors begin to pay close attention to contributing factors to post-PCNL fever. This review mainly focuses on possible mechanism of fever following PCNL and identifying the preoperative and intra-operative factors that might affect development of fever following PCNL. According to recent foreign and domestic data, factors possibly affecting fever following percutaneous nephrolithotomy are diabetes, pre-operative use of a nephrostomy tube, operative time, stone composition and shape,purulent fluid in the pelvicaliceal system, operative time, perfusate quantity. Although appropriate treatment of preoperative urinary infections may not prevent fevor or a postoperative systemic response after PCNL but it seems to result in a decreased rate of bacteremia and possibly hastened recovery from systemic inflammatory response syndrome （SIRS）. Pre-operative urinary culture, stone and pelvic urine culture, providing an important foundation of antibiotic selection for the treatment of postoperative fever, are predictors of fever.