HIV感染者/AIDS患者外科手术后的临床观察
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摘要
目的探讨不同特征HIV感染者/AIDS患者(HIV/AIDS)外科手术后切口愈合率和脓毒症情况。方法回顾性分析玉溪市某医院外科2015—2018年开展外科手术的HIV/AIDS人口学信息、临床指标及手术特征,分别计算手术后切口愈合率和脓毒症发病率情况。结果 68例HIV/AIDS中,甲、乙、丙级伤口愈合率分别为88.24%(60/68)、7.35%(5/68)、4.41%(3/68)。不同感染途径、诊断时间、机会性感染状况、手术切口类型的伤口愈合率不同(P<0.05)。手术后21例出现脓毒症,发病率为30.88%,其中严重脓毒症2例。手术时CD4值<200 cells/μL(OR=2.29,95%CI:1.86～4.62)、没有抗病毒治疗(OR=3.02,95%CI:1.96～4.22)、HCV感染(OR=3.32,95%CI:2.10～5.02)、术前机会性感染(OR=2.41,95%CI:1.12～4.67)、肝功能异常(OR=1.91,95%CI:1.17～3.10)以及白细胞水平异常(OR=4.94,95%CI:3.00～8.43)更容易术后发生脓毒症。结论可针对引起愈合不佳和脓毒症的影响因素采取相应的预防措施,对切口愈合较差和易于出现术后脓毒症的手术病人需特别加以关注。
Objective To explore the proportion the healing of the surgical incision and sepsis in HIV/AIDS patients who had received surgery. Methods We conducted a retrospective study using information including demographics, clinical indicators and surgical features among HIV/AIDS who underwent surgery in a hospital of Yuxi between 2015 and 2018.Results Among the 68 patients, 88.24%(60/68) of the incisions resulted in level A healing, 7.35%(5/68) resulted in level B and 4.41%(3/68) in level C. The proportion the surgical incision were different in route of HIV infection, time that HIV diagnose, whether opportunistic infected, typology of incision, there were of statistical significance(P<0.05); 30.88%(21 cases)of the patients with the onset of sepsis and 2 with severe sepsis. Multivariate logistic regression analyses indicated that CD4+T lymphocyte cell counts 200 cells/μL(OR=2.29,95%CI:1.8-4.62), not received antiretroviral treatment(OR=3.02,95%CI:1.96-4.22), HCV coinfected(OR=3.32,95%CI:2.10-5.02), opportunistic infected(OR=2.41,95%CI:1.12-4.67), abnormal liver function(OR=1.91,95%CI:1.17-3.10), and abnormal leukocyte counts(OR=4.94,95%CI:3.00-8.43)were more likely had been sepsis in HIV/AIDS patients who had received surgery. Conclusion Corresponding preventive measures need be taken according to the influencing factors of worse healing and onset of sepsis, the exclusion criteria in HIV/AIDS patients who had received surgery need to pay attention to those incisions resulted in worse healing and those with the onset of sepsis.
Objective To explore the proportion the healing of the surgical incision and sepsis in HIV/AIDS patients who had received surgery. Methods We conducted a retrospective study using information including demographics, clinical indicators and surgical features among HIV/AIDS who underwent surgery in a hospital of Yuxi between 2015 and 2018.Results Among the 68 patients, 88.24%(60/68) of the incisions resulted in level A healing, 7.35%(5/68) resulted in level B and 4.41%(3/68) in level C. The proportion the surgical incision were different in route of HIV infection, time that HIV diagnose, whether opportunistic infected, typology of incision, there were of statistical significance(P<0.05); 30.88%(21 cases)of the patients with the onset of sepsis and 2 with severe sepsis. Multivariate logistic regression analyses indicated that CD4+T lymphocyte cell counts 200 cells/μL(OR=2.29,95%CI:1.8-4.62), not received antiretroviral treatment(OR=3.02,95%CI:1.96-4.22), HCV coinfected(OR=3.32,95%CI:2.10-5.02), opportunistic infected(OR=2.41,95%CI:1.12-4.67), abnormal liver function(OR=1.91,95%CI:1.17-3.10), and abnormal leukocyte counts(OR=4.94,95%CI:3.00-8.43)were more likely had been sepsis in HIV/AIDS patients who had received surgery. Conclusion Corresponding preventive measures need be taken according to the influencing factors of worse healing and onset of sepsis, the exclusion criteria in HIV/AIDS patients who had received surgery need to pay attention to those incisions resulted in worse healing and those with the onset of sepsis.
引文
[1]马懿,董文斌,李世福,等.玉溪市2006-2016年新报告HIV/AIDS基线免疫状况分析[J].中国热带医学,2019(2):120-123.
[2]李世福,郭春园,李再友,等.玉溪市某医院≥50岁及<50岁人群HIV/AIDS疫情对比分析[J].中国皮肤性病学杂志,2016,30(4):376-379.
[3]张建秋,高丽娟,阮建文,等.不同CD4~+基线值艾滋病患者高效抗逆转录病毒治疗后免疫重建效果观察[J].中国热带医学,2018,18(9):931-935.
[4]OKUMU G,MAKOBORE P,KAGGWA S,et al.Effect of emergency major abdominal surgery on CD4 cell count among HIV positive patients in a sub-Saharan Africa tertiary hospital:A prospective study[J].BMC Surg,2013,13:4.
[5]刘保池,冯铁男,冯秀岭,等.HIV感染者合并外科疾病分类及临床特点分析[J].中华急诊医学杂志,2014,23(8):926-929.
[6]JACOFSKY D.The incidence and consequences of early wound infection after internal fixation for trauma in HIV-positive patients[J].Orthopedics,2013,36(5):378-379.
[7]Politics Program,La Trobe University.Antiretroviral therapy for HIV infection in adults and adolescents:recommendations for a public health approach[R].Geneva Switzerland WHO,2006.
[8]钱南平,李志刚,魏兴随,等.艾滋病患者急诊手术的围手术期处理[J].中国医药科学,2012,2(9):133-134.
[9]刘立,刘保池.CD4 T淋巴细胞计数与HIV感染者手术风险评估[J].中华全科医学,2011,9(1):7-8.
[10]LEVY M M,FINK M P,MARSHALL J C,et al.2001 SCCM/ESICM/ACCP/ATS/SIS international sepsis definitions conference[J].Crit Care Med,2003,31(4):1250-1256.
[11]贾清,马韶辉,汪春翔,等.127例HIV/AIDS患者抗病毒治疗1年CD4~+T淋巴细胞结果[J].中国热带医学,2017(5):489-491.
[12]李世福,付金翠,李再友,等.静脉注射吸毒人群HIV/HCV混合感染者与HIV单独感染者艾滋病疾病进展比较分析[J].中华微生物学和免疫学杂志,2015,35(9):692-697.
[13]KARPELOWSKY J S,LEVA E,KELLEY B,et al.Outcomes of human immunodeficiency virus-infected and-exposed children undergoing surgery:A prospective study[J].Journal of Pediatric Surgery,2009,44(4):681-687.
[14]KIGERA J W,STRAETEMANS M,VUHAKA S K,et al.Is there an increased risk of post-operative surgical Site infection after orthopaedic surgery in HIV patients?A systematic review and meta-analysis[J].PLoS One,2012,7(8):e42254.
[15]杨涤,赵红心,郜桂菊,等.HIV/AIDS手术切口愈合与CD4~+T淋巴细胞计数的关系[J].中华流行病学杂志,2014,35(12):1333-1336.2018-12-18
[2]李世福,郭春园,李再友,等.玉溪市某医院≥50岁及<50岁人群HIV/AIDS疫情对比分析[J].中国皮肤性病学杂志,2016,30(4):376-379.
[3]张建秋,高丽娟,阮建文,等.不同CD4~+基线值艾滋病患者高效抗逆转录病毒治疗后免疫重建效果观察[J].中国热带医学,2018,18(9):931-935.
[4]OKUMU G,MAKOBORE P,KAGGWA S,et al.Effect of emergency major abdominal surgery on CD4 cell count among HIV positive patients in a sub-Saharan Africa tertiary hospital:A prospective study[J].BMC Surg,2013,13:4.
[5]刘保池,冯铁男,冯秀岭,等.HIV感染者合并外科疾病分类及临床特点分析[J].中华急诊医学杂志,2014,23(8):926-929.
[6]JACOFSKY D.The incidence and consequences of early wound infection after internal fixation for trauma in HIV-positive patients[J].Orthopedics,2013,36(5):378-379.
[7]Politics Program,La Trobe University.Antiretroviral therapy for HIV infection in adults and adolescents:recommendations for a public health approach[R].Geneva Switzerland WHO,2006.
[8]钱南平,李志刚,魏兴随,等.艾滋病患者急诊手术的围手术期处理[J].中国医药科学,2012,2(9):133-134.
[9]刘立,刘保池.CD4 T淋巴细胞计数与HIV感染者手术风险评估[J].中华全科医学,2011,9(1):7-8.
[10]LEVY M M,FINK M P,MARSHALL J C,et al.2001 SCCM/ESICM/ACCP/ATS/SIS international sepsis definitions conference[J].Crit Care Med,2003,31(4):1250-1256.
[11]贾清,马韶辉,汪春翔,等.127例HIV/AIDS患者抗病毒治疗1年CD4~+T淋巴细胞结果[J].中国热带医学,2017(5):489-491.
[12]李世福,付金翠,李再友,等.静脉注射吸毒人群HIV/HCV混合感染者与HIV单独感染者艾滋病疾病进展比较分析[J].中华微生物学和免疫学杂志,2015,35(9):692-697.
[13]KARPELOWSKY J S,LEVA E,KELLEY B,et al.Outcomes of human immunodeficiency virus-infected and-exposed children undergoing surgery:A prospective study[J].Journal of Pediatric Surgery,2009,44(4):681-687.
[14]KIGERA J W,STRAETEMANS M,VUHAKA S K,et al.Is there an increased risk of post-operative surgical Site infection after orthopaedic surgery in HIV patients?A systematic review and meta-analysis[J].PLoS One,2012,7(8):e42254.
[15]杨涤,赵红心,郜桂菊,等.HIV/AIDS手术切口愈合与CD4~+T淋巴细胞计数的关系[J].中华流行病学杂志,2014,35(12):1333-1336.2018-12-18
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