目的：探讨影响高CT值梗阻结石老年患者经皮肾镜取石术（PCNL）术后尿源性脓毒血症的危险因素并建立列线图模型。方法：回顾性分析我院2020年12月至2023年12月收治的110例行PCNL术老年患者的临床资料，根据术后是否发生尿源性脓毒血症分为尿源性脓毒血症组（10例）和无尿源性脓毒血症组（100例）。比较两组患者的临床资料，采用多因素Logistic回归分析影响PCNL术后尿源性脓毒血症的危险因素。分析相关指标单独及联合检测预测尿源性脓毒血症的价值。结果：尿源性脓毒血症组与无尿源性脓毒血症组患者临床资料比较，是否合并糖尿病、结石直径、手术时长、尿白细胞数差异有统计学意义（P<0.05）。多因素回归分析结果显示，合并糖尿病（OR=15.64，95%CI 1.33~184.31）、手术时长（OR=0.85，95%CI 0.75~0.98）、尿白细胞数（OR=0.54，95%CI 0.35~0.83）为PCNL术后发生尿源性脓毒血症的危险因素（P<0.05）。本研究建立了预测模型：Logit（P）=23.885+0.536×尿白细胞数+0.854×手术时长+15.639×（是否合并糖尿病，是=1，否=0）。根据Hosmer-Lemeshow检验结果（χ²＝9.003，P＝0.342），该模型的拟合度较好。尿白细胞数、手术时长、合并糖尿病联合预测尿源性脓毒血症的ROC曲线下面积高于各单一指标预测（P<0.05）。结论：高CT值梗阻结石老年患者PCNL术后尿源性脓毒血症危险因素包括合并糖尿病、手术时长、尿白细胞数，基于上述危险因素建立的列线图模型可准确评估和量化PCNL术后尿源性脓毒血症发生风险。临床应警惕相关危险因素，加强综合化管理防控，降低尿源性脓毒血症发生率。

Objective： To investigate the risk factors of urosepsis after percutaneous nephrolithotomy （PCNL） in elderly patients with obstructive calculi with high CT value and to establish a nomogram model.Methods： The clinical data of 110 elderly patients undergoing PCNL surgery admitted to our hospital from December 2020 to December 2023 were retrospectively analyzed. According to whether urosepsis occurred after surgery， the patients were divided into the urosepsis group （10 cases） and the non-urosepsis group （100 cases）. The clinical data of the two groups were compared. Multivariate Logistic regression analysis was used to analyze the risk factors of urosepsis after PCNL. The value of single and combined detection of related indicators in predicting urosepsis was analyzed.Results： There were statistically significant differences in the clinical data between the urosepsis group and the non-urosepsis group， including diabetes mellitus， stone diameter， operation duration， and urinary white blood cell count （P<0.05）. Multivariate regression analysis showed that comorbid diabetes mellitus （OR=15.64， 95%CI 1.33-184.31）， operation duration （OR=0.85， 95%CI 0.75-0.98）， urinary white blood cell count （OR=0.54， 95%CI 0.35-0.83） were risk factors for urosepsis after PCNL surgery （P<0.05）. This study established a prediction model： Logit（P） = 23.885+0.536× urinary white blood cell count +0.854×operation duration +15.639×（whether diabetes is complicated， yes =1， no =0）. According to the Hosmer-Lemeshow test results （χ² = 9.003， P = 0.342）， the model had a good degree of fit. The area under the ROC curve of the combination of urinary white blood cell count， operation duration， and comorbid diabetes for predicting urosepsis was higher than that of each index alone （P<0.05）.Conclusion： There are many risk factors for urosepsis after PCNL in elderly patients with high CT value obstructive calculi， including comorbid diabetes mellitus， operation duration， and urinary white blood cell count. The nomogram model established based on the above risk factors can accurately evaluate and quantify the risk of urosepsis after PCNL. It is necessary to be vigilant to related risk factors， strengthen integrated management and prevention， and reduce the incidence of urosepsis.