HIV感染者围手术期营养支持治疗

目的探讨营养不良HIV感染者围手术期营养支持治疗的效果。方法回顾性分析2008年10月至2012年2月上海市公共卫生临床中心外科手术治疗的283例HIV感染者的临床资料。283例中营养不良者35例，排除7例因急诊手术未进行术前营养支持治疗，共28例患者纳入研究；营养正常者248例。营养不良患者术前5—7d给予营养支持，术后所有患者给予营养支持。对营养不良患者免疫功能、营养状况、手术切口感染、术后脓毒症和围手术期病死率进行分析。计量资料采用配对t检验，计数资料采用列联表，检验。结果营养不良患者经过术前营养支持治疗后，CD4、CD8、Hb分别为（205±24）×10。个／L、（559±55）×10。个／L、（103±24）g／L，明显高于未治疗前的（150±33）×10。个／L、（491±45）×10。个／L、（97±19）g／L（t=-2．561，-1．302，-1．349，P〈0．05）；手术治疗第14天复查上述指标分别为（197±43）×10。个／L、（547±52）×10。个／L、（103±22）g／L，较术前营养支持治疗后略有下降，但差异无统计学意义（t=-1．108，0．600，-0．148，P〉0．05）。营养不良患者手术切口感染率为42．9％（12／28），低于营养正常患者的45．2％（112／248），但两者比较，差异无统计学意义（P〉0．05）。营养不良患者术后脓毒血症发生率和围手术期病死率分别为75．0％（21／28）和3．6％（1／28），明显高于营养正常患者的32．7％（81／248）和0．8％（2／248），两者比较，差异有统计学意义（P〈0．05）。结论HIV感染者在围手术期进行合理的营养支持治疗在-定程度上能够提高患者的免疫能力。

Nutritional support for human immunodeficiency virus-infected patients during perioperative period

Objective To investigate the efficacy of nutritional support for human immunodeficiency virus （HIV）-infected and malnutritional patients during perioperative period. Methods The clinical data of 283 HIV- infected patients who were admitted to the Shanghai Public Health Clinical Center from October 2008 to February 2012 were retrospectively analyzed. All patients were divided into malnutritional group and non-malnutritional group according to nutritional condition before operation. Twenty-eight patients with malnutrition （7 patients did not receive perioperative nutritional support due to emergency operation, and they were excluded from the study） and 248 patients in normal nutritional status were enrolled in the study. Nutritional support was given for 5-7 days before operation for patients with malnutrition, and all patients received nutritional support after operation. Differences in the immune function, nutrional status, the incidences of surgical incisional infection and sepsis, and peri- operative mortality between the 2 groups were compared. Measurement data were analyzed using the paired t test, and the enumeration data were analyzed using the chi-square test. Results The levels of CD4, CD8 and hemo- globin in patients with malnutrition were （ 205 ± 24 ） x 106/L, （ 559 ± 55 ） ~ 106/L and （ 103 ± 24 ） g/L after perio- perative nutritional support, which were significantly higher than （150 ± 33）× 10^6/L, （491 ± 45 ） × 10^6/L and （97 ± 19） g/L before nutritional support （t = - 2. 561, - 1. 302, - 1. 349, P 〈 0.05 ）. The levels of CD4, CD8 and hemoglobin were （ 197 ± 43 ） × 10^6/L, （547 ± 52）× 10^6/L and （ 103 ± 22） g/L at postoperative day 14, which were decreased compared with those after nutritional support, while no significant difference was detected （t = - 1. 108, 0. 600, - 0. 148, P 〉 0.05 ）. The incidence of incisional infection in patients with malnutrition was 42.9% （12/28）, which was lower than 45.2% （112/248 ） of patients in normal nutritional status, with no signifi- cant difference （P 〉 0.05 ）. The incidence of postoperative sepsis and perioperative mortality were 75.0% （21/28） and 3.6% （1/28） in patients with malnutrition after operation, which were significantly higher than 32.7% （81/248） and 0.8% （2/248） in patients in normal nutritional status （ P 〈 0.05 ）. Conclusion The mobidity of HIV-infected patients is high, and nutritional support for HIV-infected patients during perioperative period can improve their immunity.