目的分析结石性脓肾患者感染特点和经皮肾镜碎石术(percutaneous nephrolithotomy,PCNL)后发生全身炎症反应综合征(systemic inflammatory respo-nse syndrome,SIRS)的相关危险因素。方法回顾性分析我院2011年1月至2015年12月收治的所有术前7d无发热的结石性脓肾患者PCNL手术资料。统计并分析患者术前尿培养常见病原菌的种类特点、比例和耐药性。同时用多因素logistic回归分析患者年龄、性别、术前尿培养、术前抗生素使用≥3d、鹿角形结石、手术时间等14个因素对患者术后SIRS的影响。结果共纳入69例结石性脓肾患者,术前尿培养共分离出47株病原菌,以大肠埃希菌(30例)、奇异变形杆菌(8例)等革兰阴性杆菌(G-杆菌)为主。多数G-杆菌主要对头霉素类、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦及碳青霉烯类等药物敏感。术后21例(30.4%)患者发生SIRS,多因素logistic回归显示:手术时间≥60min[标准偏回归系数(Beta)=0.378,比值比(OR)=4.483,95%可信区间(CI)1.111~18.100,P=0.035]为结石性脓肾PCNL术后发生SIRS的独立危险因素,术前使用抗生素≥3d(Beta=-0.450,OR=0.194,95%CI 0.051~0.741,P=0.017)和术前使用敏感抗菌药物(Beta=-0.610,OR=0.102,95%CI0.017~0.602,P=0.012)两个因素能降低SIRS的发生。一期手术与二期手术两组患者的清石率及术后发生SIRS、出血等相关并发症发生率的差异无统计学意义。二期手术可降低术后住院时间(P=0.047),但总住院时间较一期组延长(P<0.001)。结论结石性脓肾患者术前尿培养病原菌以G-杆菌为主,且耐药率高。一期PCNL治疗结石性脓肾安全有效,减少手术时间并术前使用敏感抗菌药物治疗≥3d可有效降低SIRS发生风险。 Objective To analyze the infection characteristics of patients with calculous pyogenic kidney and the related risk factors of systemic inflammatory response syndrome (SIRS) after percutaneous nephrolithotomy (PCNL). Methods The clinical data of PCNL in all patients with pythroid calculus who did not have fever 7 days before operation from January 2011 to December 2015 in our hospital were retrospectively analyzed. Statistics and analysis of patients with preoperative urine culture of common pathogenic bacteria characteristics, proportions and drug resistance. At the same time, multivariate logistic regression analysis of the patient’s age, gender, preoperative urinary culture, preoperative antibiotic use ≥ 3d, antler stones, operation time and other 14 factors on postoperative SIRS. Results A total of 69 patients with calculous pyogenic kidney were enrolled in this study. A total of 47 strains of pathogens were isolated from preoperative urinary culture. Gram-negative bacilli (G-bacteria) such as Escherichia coli (30 cases) and Proteus mirabilis the Lord. Most G-bacilli are primarily susceptible to drugs such as cephamycins, piperacillin / tazobactam, cefoperazone / sulbactam and carbapenems. SIRS occurred in 21 patients (30.4%) after operation, and the multivariate logistic regression showed that the operation time was more than 60 minutes (standard deviation of regression coefficient = 0.378, odds ratio = 4.483, 95% confidence interval (CI) ~ 18.100, P = 0.035] were the independent risk factors of SIRS in patients with calculous pyogenic kidney after PCNL. The patients were treated with antibiotics ≥3d before surgery (Beta = -0.450, OR = 0.194, 95% CI 0.051-0.741, P = 0.017) Preoperative use of sensitive antibiotics (Beta = -0.610, OR = 0.102, 95% CI0.017 ~ 0.602, P = 0.012) two factors can reduce the incidence of SIRS. There was no significant difference in the rates of clear stone and incidence of postoperative SIRS and bleeding among the two groups in stage I and stage II surgery. Second-stage surgery reduced postoperative hospital stay (P = 0.047), but overall hospital stay was longer (P <0.001) than in first-stage surgery. Conclusions Preoperative urinary culture of pathogenic bacteria in patients with calculous pyogenic kidney is mainly G-bacilli, and the drug resistance rate is high. A PCNL treatment of calculous pyogenic kidney safe and effective, reduce the operation time and preoperative use of sensitive antimicrobial drugs for 3d can effectively reduce the risk of SIRS.