| 摘要: |
| 目的 探讨甲泼尼龙（METH）预处理对高危患者经皮肾镜取石术（PCNL）后尿脓毒症发生的影响。方法 前瞻性选择80例接受PCNL且具有尿脓毒症高危因素的患者，采用按性别分层的随机序列分为METH组（n=40）和对照组（n=40）。全身麻醉诱导后，在手术操作前METH组患者静脉推注METH 40 mg，而对照组患者静脉推注同等体积的生理盐水。主要研究结果为术后尿脓毒症的发生率（脓毒症3.0版定义）；次要结果包括尿脓毒性休克和全身炎症反应综合征（SIRS）的发生率，以及术后2 h、24 h血浆中炎症标志物（CRP、前降钙素原、TNF-α、IL-1β、IL-6、IL-10）水平的变化。结果 纳入的80例患者中有6例被剔除。术前两组患者基线值差异无统计学意义（P>0.05）。METH组（n=37）术后尿脓毒症、尿脓毒性休克和SIRS的发生率分别为5.4%（2/37）、0和18.9%（7/37），而对照组（n=37）分别为24.3%（9/37）、10.8%（4/37）和51.4%（19/37），两组尿脓毒性休克发生率的差异无统计学意义（P>0.05），尿脓毒症和SIRS的发生率的差异均有统计学意义（P<0.05，P<0.01）。术后2 h METH组患者血浆中IL-10水平高于对照组［26.3（149.5）pg/mL vs 5.0（3.6）pg/mL，P<0.01］，但术后24 h患者血浆中IL-10水平低于对照组［<5.0（1.5）pg/mL vs 5.9（13.8）pg/mL，P<0.05］。对照组患者术后24 h血浆中IL-6水平高于METH组［34.4（46.5）pg/mL vs 20.7（15.8）pg/mL，P<0.01］。其他炎症标志物两组间差异均无统计学意义（P均>0.05）。结论 METH预处理可降低高危患者PCNL术后尿脓毒症和SIRS的发生率，这种保护作用可能是预防性给予METH促进了炎症反应起始阶段IL-10的释放，从而抑制后续的过度炎症反应。 |
| 关键词: 尿脓毒症 甲泼尼龙 预处理 经皮肾镜取石术 随机对照试验 |
| DOI：10.16781/j.0258-879x.2021.01.0021 |
| 投稿时间：2020-10-22修订日期：2020-12-05 |
| 基金项目:上海市科学技术委员会2019年度医学引导类（中、西医）科技支撑项目（19411967500）. |
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| Methylprednisolone prevents urosepsis in high-risk patients undergoing percutaneous nephrolithotomy: a randomized controlled trial |
| XI Peng1△,ZHOU Yi1△,LI Xiao-fei1,CHEN Yuan-jie1,PENG Yong-han2,LIU Yi1* |
(1. Faculty of Anesthesiology, Changhai Hospital, Naval Medical University(Second Military Medical University), Shanghai 200433, China;
2. Department of Urology, Changhai Hospital, Naval Medical University(Second Military Medical University), Shanghai 200433, China
△Co-first authors.
* Corresponding author) |
| Abstract: |
| Objective To investigate the effect of methylprednisolone (METH) pretreatment on the incidence of urosepsis post percutaneous nephrolithotomy (PCNL) in patients with high-risk factors. Methods Eighty patients who underwent PCNL with high-risk factors of postoperative urosepsis were prospectively selected in this study. They were stratified by gender and randomized into METH or control groups (n=40 in each group). After induction of general anesthesia, 40 mg METH was intravenously administered in METH group before operation, while the equal volume of normal saline was done in the control group. The primary outcome was the incidence of postoperative urosepsis (according to Sepsis 3.0 definition). The secondary outcomes included the incidences of uroseptic shock and system inflammatory response syndrome (SIRS), and the changes of plasma levels of inflammatory markers (C reactive protein[CRP], procalcitonin, tumor necrosis factor α[TNF-α], interleukin[IL]-1β, IL-6, and IL-10) at 2 h and 24 h after operation. Results Six out of 80 patients were excluded. There was no significant difference in the baseline characteristics between the two groups before operation (P>0.05). The incidences of postoperative urosepsis, uroseptic shock and SIRS were 5.4% (2/37), 0 and 18.9% (7/37) in METH group (n=37), and 24.3% (9/37), 10.8% (4/37) and 51.4% (19/37) in the control group (n=37), respectively, with no significant difference in the incidence of uroseptic shock (P>0.05), but with significant differences in the incidences of urinary sepsis and SIRS between the two groups (P<0.05, P<0.01). The plasma level of IL-10 in METH group was higher than that in the control group at 2 h after operation (26.3[149.5] pg/mL vs 5.0[3.6]pg/mL, P<0.01), but lower than that in the control group at 24 h after operation (<5.0[1.5] pg/mL vs 5.9[13.8]pg/mL, P<0.05). The plasma level of IL-6 in the control group was higher than that in METH group at 24 h after operation (34.4[46.5]pg/mL vs 20.7[15.8]pg/mL, P<0.01). No significant difference was found in the levels of other inflammatory markers between the two groups (all P>0.05). Conclusion METH pretreatment can decrease the incidences of urosepsis and SIRS in high-risk patients undergoing PCNL. This protective effect may be attributed to METH pretreatment facilitating the release of IL-10 at the initial stage of inflammatory response, and then inhibiting the subsequent excessive inflammatory response. |
| Key words: urosepsis methylprednisolone pretreatment percutaneous nephrolithotomy randomized controlled trial |
