Comparative Study On The Changes Of Inflammatory Markers Of Systemic Infection Driven By Pressure Between Upper And Lower Urinary Tracts

Objective: To explore the changes of perioperative inflammatory markers in patients with pressure-driven upper and lower urinary tract surgery and the difference between the upper and lower urinary tracts,and preliminary reveals the relationship between urinary tract infection and even urinary sepsis in patients undergoing u pper and lower urinary tract endovascular surgery,and the microecological changes of the body infection,and the intraoperative urinary tract perfusion pressure.Methods: This study collected patients who underwent upper and lower urinary tract surgery in our hospital from October-2019 to December-2020 and met the inclusion and exclusion criteria formulated by the institute,measure the patient’s peripheral blood white blood cell count,percentage of neutrophils,C-reactive protein(CRP),interleukin-6(IL-6),serum amyloid-A(SAA),white blood cell count and endotoxin level in urine within 72 hours before surgery and within 2 hours after surgery;During the operation,the pipeline is used to connect the intraoperative perfusion line,and then the baroreceptor is used to connect the pressure signal acquisition and processing system of the computer to determine the maximum pressure,total pressure(area under the pressure-time curve)and average pressure of the urinary tract perfusion during the operation;The included patients were then divided into upper urinary tract surgery group and lower urinary tract surgery group,and the measured indicators were statistically analyzed to analyze the differences in the above-mentioned inflammation markers between the upper and lower urinary tract surgery groups before and after the operation;The difference of intraoperative perfusion pressure between surgical groups;the correlation between the above-mentioned infectious inflammation markers and perfusion pressure in the upper and lower urinary tract surgery group;the difference between the cases of urinary tract infection and those without urinary tract infection in the upper and lower urinary tract surgery group the difference in perfusion pressure.Results: This study collected 84 cases that met the standards and had complete clinical data,including 52 cases in the upper urinary tract surgery group and 32 cases in the lower urinary tract surgery group.Analysis result: ⑴Inflammation markers comparison between upper and lower urinary tract surgery groups: There was no significant difference in WBC,neutrophil percentage,CRP,IL-6,SAA in peripheral blood before operation(all P>0.05),the level of urinary endotoxin and the number of white blood cells in the upper urinary tract surgery group were significantly higher than those in the lower urinary tract surgery group(all P<0.05);There were no significant differences in WBC,IL-6,SAA,urine endotoxin levels and the number of white blood cells in urine after surgery(all P>0.05),while the percentage of neutrophils and CRP in the upper urinary tract surgery group after surgery Significantly lower than the lower urinary tract surgery group(all P<0.05);(2)Comparison of inflammation markers before and after operation in the upper and lower urinary tract surgery group: In the upper urinary tract surgery group,the percentage of neutrophils,CRP,and IL-6 after surgery were significantly higher than those before surgery(all P<0.05),while the level of endotoxin in urine and the number of white blood cells in urine were significantly lower than those before surgery(all P<0.05);In the lower urinary tract surgery group,postoperative WBC,neutrophil percentage,CRP,IL-6,and SAA were significantly higher than the preoperative level(all P<0.05),while the urine endotoxin level was significantly lower than the preoperative level(P<0.05);⑶ Comparison of intraoperative perfusion pressure in upper and lower urinary tract surgery groups: The highest pressure and average pressure of intraoperative perfusion in the upper urinary tract surgery group were significantly higher than those in the lower urinary tract surgery group(all P<0.001),while the total pressure was significantly lower than that in the lower urinary tract surgery group(P=0.001);⑷ The relationship between intraoperative perfusion pressure and postoperative infectious inflammation markers:There was a significant positive correlation between the highest intraoperative perfusion pressure in the upper urinary tract surgery group and the postoperative peripheral blood WBC,IL-6,and urine endotoxin levels(all P<0.05).There was a significant positive correlation between total perfusion pressure and peripheral blood WBC,percentage of neutrophils,CRP,and endotoxin levels in urine after surgery(all P<0.05).There was a significant positive correlation between the average perfusion pressure and the peripheral blood WBC,neutrophil percentage,CRP,and urinary endotoxin levels in patients after surgery(P<0.05);There was a significant positive correlation between the highest intraoperative perfusion pressure in the lower urinary tract surgery group and the postoperative peripheral blood WBC and urine endotoxin levels(all P<0.05).There was a significant positive correlation between total perfusion pressure and peripheral blood WBC,percentage of neutrophils,CRP,and urine endotoxin levels in patients after surgery(all P<0.05).There was a significant positive correlation between average perfusion pressure and peripheral blood WBC,percentage of neutrophils,CRP,and urine endotoxin levels after surgery(all P<0.05).Conclusion: Pressure-driven endoluminal surgery,on the one hand,can reduce the number of pathogenic bacteria in the urinary tract by removing the obstruction,draining urine,and reducing the number of pathogenic bacteria present in the urinary tract;however,the surgery can also activate the inflammatory response and cause the level of infectious inflammation markers in the body to increase,may further cause urinary sepsis or even septic shock;Increased levels of infectious inflammation markers are closely related to intraoperative perfusion pressure;The inflammation activation mechanism not only exists in the upper urinary tract surgery,but also exists in the lower urinary tract surgery,suggesting that during the lower urinary tract surgery,attention should be paid to reduce the intraoperative perfusion pressure as much as possible to reduce the risk of postoperative urinary infection.