Retrospective analysis for the effect of a single low dose of methylprednisolone on systemic inflammatory response syndrome after percutaneous nephrolithotomy

doi:10.3969/j.issn.1009-976X.2021.06.014

Abstract

Abstract: Objective To explore the effect of a single low dose of methylprednisolone on systemic inflammatory response syndrome （SIRS） after percutaneous nephrolithotomy （PCNL）. Methods There were 315 patients diagnosed with renal calculi and received PCNL in the urology Department of our hospital from January 2019 to May 2021. After exclusion, 237 cases were included in the statistical analysis. And the patients were divided into two groups according to whether methylprednisolone was used before the operation. The incidence of SIRS and the data of other prognostic indicators were recorded. Results There were 120 patients in the methylprednone group and 117 patients in the control group. There was no significant different between the two groups about preoperative baseline indicators（P<0.05）. Indicators： Compared with the control group, the PCT and HSCRP of the methylprednone group were lower at postoperative hour two and atpostoperative day one（P<0.05）. Clinical outcomes showed incidence of fever on the day of surgery and postoperative hospital stay in the methylprednone group were lower than that in the control group（P<0.05）. There was no significant difference between the two groups in the incidence of SIRS, positive blood culture, sepsis, ICU stay（P>0.05）. Conclusion A single low dose of methylprednone before PCNL was beneficial for decreasing levels of PCT and HSCRP, caused a shorter postoperative hospital stay. It has no preventive effect on the occurrence of postoperative SIRS.

Key words: methylprednisolone, percutaneous nephrolithotripy, systemic inflammatory response synodrome, glucocorticoid

摘要： 目的探讨术前单次小剂量甲强龙对经皮肾镜碎石取石术（PCNL）术后全身炎症反应综合征（SIRS）的影响。方法回顾性收集2019年1月至2021年5月期间在我院泌尿外科接受PCNL的患者资料315例,经排除最终纳入237例。根据术前是否使用甲强龙分为两组,对比两组术后SIRS的发生率及其他预后指标。结果甲强龙组患者120例,对照组117例,两组患者术前基线临床资料无统计学差异（P>0.05）。甲强龙组术后2小时降钙素原（PCT）及超敏C反应蛋白（HSCRP）、术后1天PCT及HSCRP低于对照组（P<0.05）;甲强龙组术后当天发热率、术后住院时间低于对照组（P<0.05）;两组术后SIRS发生率、术后血培养阳性率、脓毒血症发生率、重症监护病房（ICU）住院率均无统计学差异。结论术前单次小剂量甲强龙可降低PCNL患者术后PCT及HSCRP水平、手术当天发热率、术后住院时间,但对术后SIRS的发生无预防作用。

关键词: 甲强龙, 经皮肾镜碎石取石术, 全身炎症反应综合征, 糖皮质激素

CLC Number:

R692.4

ZHAO Peng-peng, HUANG Jian-hua, XU Zhan-ping. Retrospective analysis for the effect of a single low dose of methylprednisolone on systemic inflammatory response syndrome after percutaneous nephrolithotomy[J]. Lingnan Modern Clinics In Surgery, 2021, 21(06): 658-662.

赵朋朋, 黄剑华, 徐战平. 术前单次小剂量甲强龙对经皮肾镜碎石取石术后全身炎症反应综合征影响的回顾性研究[J]. 岭南现代临床外科, 2021, 21(06): 658-662.

References

[1] Wollin DA, Preminger GM.Percutaneous nephrolithotomy: complications and how to deal with them[J]. Urolithiasis, 2018, 46(1):87-97.
[2] Moses RA, Agarwal D, Raffin EP, et al.Postpercutaneous nephrolithotomy systemic inflammatory response syndrome is not associated with unplanned readmission[J]. Urol, 2017, 100: 33-37.
[3] Tang Y, Zhang C, Mo C, et al.Predictive model for systemic infection after percutaneous nephrolithotomy and related factors analysis[J]. Front Surg, 2021, 8:696463.
[4] Sur RL, Krambeck AE, Large T, et al.A Randomized Controlled Trial of Preoperative Prophylactic Antibiotics for Percutaneous Nephrolithotomy in Moderate to High Infectious Risk Population: A Report from the EDGE Consortium[J]. J Urol, 2021, 205(5): 1379-1386.
[5] Liu M, Chen J, Gao M, et al.Preoperative midstream urine cultures vs renal pelvic urine culture or stone culture in predicting systemic inflammatory response syndrome and urosepsis after percutaneous nephrolithotomy: a systematic review and meta-analysis[J]. J Endourol, 2021, 35(10): 1467-1478.
[6] Bai Y, He H, Zhang P, et al.Effects of dexmedetomidine on immune function, renal function and inflammatory factors of patients undergoing percutaneous nephrolithotomy under general anesthesia[J]. Exp Ther Med, 2021, 21(4):406.
[7] 程楠,谭芳,胡静萍,等.术中使用地塞米松对经皮肾镜术后全身炎症反应综合征影响的回顾性研究[J].中华腔镜泌尿外科杂志(电子版), 2020, 14(4): 274-278.
[8] Qi T, Qi X, Chen X,et al.The retrospective study of perioperative application of dexamethasone and furosemide for postoperative anti-inflammation in patients undergoing percutaneous nephrolithotomy[J]. Int Urol Nephrol, 2021,53(4):669-677.
[9] 周少丽, 邓颖青, 谭芳, 等.经皮肾镜碎石取石术后全身炎症反应综合症的风险因素回顾性分析[J].中山大学学报(医学科学版), 2016, 37(2): 295-299.
[10] Berardinelli F, De Francesco P, Marchioni M, et al.Infective complications after retrograde intrarenal surgery: a new standardized classification system[J]. Int Urol Nephrol, 2016, 48(11):1757-1762.
[11] Song F, Liu C, Zhang J, et al.Antibacterial effect of fosfomycin tromethamine on the bacteria inside urinary infection stones[J]. Int Urol Nephrol, 2020, 52(4):645-654.
[12] Kreydin EI, Eisner BH.Risk factors for sepsis after percutaneous renal stone surgery[J]. Nat Rev Urol, 2013, 10(10):598-605.
[13] Rivera M, Viers B, Cockerill P, et al.Pre- and Postoperative Predictors of Infection-Related Complications in Patients Undergoing Percutaneous Nephrolithotomy[J]. J Endourol, 2016, 30(9):982-986.
[14] 徐辉,谢天朋,肖日海,等.小剂量地塞米松预防经皮肾镜取石术并发全身炎症反应综合征的疗效观察[J]. 微创泌尿外科杂志, 2018,7(6): 389-392.
[15] Fihn SD.Clinical practice. Acute uncomplicated urinary tract infection in women[J]. N Engl J Med, 2003, 349(3):259-266.
[16] Akdeniz E, Ozturk K, Ulu MB, et al.Risk Factors for Systemic Inflammatory Response Syndrome in Patients with Negative Preoperative Urine Culture after Percutaneous Nephrolithotomy[J]. J Coll Physicians Surg Pak, 2021,30(4):410-416.
[17] Walton-Diaz A, Vinay JI, Barahona J, et al.Concordance of renal stone culture: PMUC, RPUC, RSC and post-PCNL sepsis-a non-randomized prospective observation cohort study[J]. Int Urol Nephrol, 2017, 49(1): 31-35.
[18] Englert KM, McAteer JA, Lingeman JE, Williams JC. Jr High carbonate level of apatite in kidney stones implies infection, but is it predictive?[J]. Urolithiasis, 2013, 41(5):389-394.
[19] Minneci PC, Deans KJ, Banks SM,et al.Meta-Analysis: The Effect of Steroids on Survival and Shock during Sepsis Depends on the Dose[J]. Ann Intern Med, 2004,141(1): 47-56.
[20] Ligtenberg JJ, Zijlstra JG.The relative adrenal insufficiency syndrome revisited: which patients will benefit from low-dose steroids?[J]. Curr Opin Crit Care, 2004,10(6): 456-460.