HIV感染者与无HIV感染者脊柱手术切口愈合情况的对比观察

目的 :比较人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染者与无HIV感染者脊柱手术后手术切口愈合的情况,初步探讨HIV感染者切口愈合不良的影响因素。方法:2011年6月~2015年6月我院手术治疗40例HIV感染的脊柱疾病患者(观察组),选取同时期与观察组性别、年龄、手术方式相匹配的40例无HIV感染的脊柱手术患者作为对照组。记录切口愈合情况,比较观察组和对照组间切口愈合不良(红肿、渗出、血肿、脂肪液化、裂开、感染等)的情况,比较HIV感染者中切口愈合不良患者与切口愈合良好患者间年龄、性别、体质指数(BMI)、白蛋白、HIV感染临床分期、CD4~+T淋巴细胞计数、手术部位、手术入路、手术节段、内固定应用情况、融合情况、手术方式(是否微创手术)、手术时间、术中出血量的差异。结果:观察组患者中,切口愈合良好32例;愈合不良8例,包括切口红肿8例、切口渗出5例、切口裂开1例、切口脂肪液化1例、切口延迟愈合1例,手术部位(切口)感染2例,均为浅表感染,1例细菌培养结果为金黄色葡萄球菌,另1例细菌培养结果阴性。对照组患者中,切口愈合良好39例;愈合不良1例,为浅表感染,细菌培养结果阴性。观察组与对照组患者年龄、性别比、BMI、手术部位、疾病种类、手术方式(是否微创手术)、切口类型、手术入路、手术节段、内固定应用情况、融合情况、手术时间和出血量方面无统计学差异(P0.05)。观察组患者与对照组患者手术部位感染率的差异无统计学意义(P0.05),切口愈合不良的差异有统计学意义(P0.05)。所有切口愈合不良患者给予及时处理后最终均获得愈合,随访无迟发感染、脓毒症及死亡。HIV感染切口愈合不良患者的CD4~+T淋巴细胞计数、HIV感染临床分期、BMI及血清白蛋白与HIV感染切口愈合良好患者比较有统计学差异(P0.05)。结论:HIV感染者较无HIV感染者更易发生脊柱手术切口愈合不良,且与HIV感染分期C期、CD4~+T淋巴细胞计数200个/μl、BMI和白蛋白较低有关。     

HIV/AIDS患者鼻出血72例的临床分析

目的分析HIV/AIDS患者鼻出血的临床特征、易发原因,以探讨临床上合适的治疗方法及预防措施。 方法将本院于2010年12月至2017年2月其他科室到耳鼻喉会诊的HIV/AIDS合并鼻出血72例患者作为调查对象,分析疾病特点,总结相关因素,探讨治疗方法及疗效。 结果患者鼻腔黏膜以干燥、溃疡、糜烂或萎缩为主（24例）,其中14例患者鼻腔黏膜水肿,22例患者合并鼻窦炎、鼻前庭炎等相关疾病;出血性质以黏膜破溃、糜烂、水肿等出血为主（37例）,其余患者为动脉出血（21例）及静脉出血（14例）;出血频次以多次为主,> 3次者47例,首次发作者17例,2~3次者8例;出血侧别以双侧为主（43例）,单侧出血者29例。以上各指标采用多个率趋势的卡方检验,差异均具有统计学意义（P均< 0.05）。72例患者中65例出现血常规、凝血功能的异常,70例患者免疫功能下降。经积极治疗后成功治愈者52例、缓解者18例、无效者2例。 结论HIV/AIDS患者鼻出血与其基础疾病相关,临床上采取鼻腔填塞及鼻内镜下微创治疗疗效良好,辅以局部可调式鼻腔冲洗器保湿护理的措施,可较好地预防、恰当地治疗,提高患者的生存质量,减轻痛苦。     

HIV／AIDS患者口腔行为及病损的调查和分析

目的了解HIV感染者和AIDS患者口腔健康行为及口腔病损的特点。方法以来本院就诊的55例HIV/AIDS患者为调查对象,对口腔健康行为进行问卷调查,对其口腔卫生状况、口腔黏膜及牙周病损进行临床检查,就CD4细胞计数和出血指数、菌斑指数进行相关性分析。结果 55例HIV/AIDS患者口腔卫生习惯和卫生状况较差,有口腔科就诊史的有34例（61.8%）,曾在传染病医院就诊的仅有1例（2.94%）;HIV相关口腔病损患者有20例（36.4%）,普通牙周病患者有42例（96.3%）,CD4细胞计数和出血指数、菌斑指数之间无显著相关性。结论随着抗病毒药物的应用,HIV/AIDS相关口腔病损发病率明显降低,而普通牙周病发病率较高,可能与口腔卫生不良有关。HIV/AIDS患者就诊口腔科的随意性强,口腔科医生在诊疗中要加强防护意识。     

HIV/AIDS合并泌尿外科疾病腔镜手术的安全性探讨

目的探讨人类免疫缺陷病毒感染者/艾滋病患者（HIV/AIDS）合并泌尿外科疾病进行腔镜手术的安全性。 方法自2015年5月至2018年4月我院对HIV/AIDS合并泌尿外科疾病患者92例施行各类腔镜手术,对其临床资料进行回顾性分析。 结果共施行92例泌尿外科腔镜手术,其中输尿管镜下碎石取石术21例、经皮肾镜碎石取石术34例、经尿道手术31例、腹腔镜手术6例。术前及术后患者白细胞、血小板、C-反应蛋白、CD4淋巴细胞计数差异无统计学意义,5例患者术后出现发热,其中1例出现脓毒血性休克,所有患者经治疗后病情好转,围手术期无死亡病例。术中发生1例职业暴露,未发现HIV感染。 结论HIV/AIDS合并泌尿系外科疾病患者进行腔镜手术,充分做好围手术期准备,对于医患而言,总体是安全的。     

护理干预对HIV/AIDS患者自我管理疾病能力的影响

目的 探讨护理干预对HIV/AIDS患者自我管理疾病能力的影响.方法 将100例HIV/AIDS患者按住院号分成干预组和对照组各50例,对照组给予常规治疗及护理,干预组在常规治疗及护理基础上,由专职的责任护士从心理、认知、行为方面进行全面系统干预.于出院后6个月复查时采用自行设计的自我管理疾病能力调查表进行问卷调查.结果 干预组自我管理能力总分、疾病认知水平、症状管理、用药依从性、生活行为方式、获得社会支持方面评分显著高于对照组(均P＜0.01).结论 全面系统的护理干预,可明显提高HIV/AIDS患者自我管理疾病能力.     

HIV/HCV共感染者细胞免疫功能及临床研究

目的探讨HIV/HCV共感染者的临床特征及其细胞免疫功能。方法分析本院2004年至2009年收治的HIV/HCV共感染者40例,分析其HIVRNA载量、HCV RNA载量、CD4细胞数以及临床特征,并以单独感染HCV患者30例和AIDS患者50例作为对照。结果与AIDS组相比,HIV/HCV共感染组血清白蛋白更低,ALT、AST和HIV RNA载量水平更高(P0.01);与HCV组比较,HIV/HCV共感染组血清白蛋白、ALT和AST水平更低(P0.01),HCV RNA载量水平更高,脾大患者明显增多(P0.01),脂肪变性及肝纤维化程度有加重趋势。CD4细胞计数依次为HIV/HCV组AIDS组HCV组正常组(P0.01)。结论 HIV/HCV共感染对HCV和HIV病毒复制水平、艾滋病患者的细胞免疫功能、慢性丙型肝炎的疾病进展等均有一定影响。     

人类免疫缺陷病毒（HIV）对骨科手术的影响

１９９１－１９９４年Ｚａｍｂｉａ大学教学医院骨科对感染ＨＩＶ与非感染ＨＩＶ的手术病人进行了临床研究。以便向病人及术者提供较确切的信息，哪些手术对于感染ＨＩＶ病人有危险，引起他们的重视，也希望获得感染ＨＩＶ病人的哪些临床指征可能增加术后合并症的发生率者与感染ＨＩＶ病人之间交叉感染的问题。     

HIV阳性患者合并泌尿系统疾病的手术处理

目的:探讨H IV阳性合并泌尿系统疾病患者的手术处理特点。方法:回顾分析1996年4月~2004年5月在援外医疗队期间收治的41例患有泌尿系统疾病的H IV阳性患者的治疗经过,并总结相关经验。结果:41例患者均接受了高效抗逆转录病毒疗法(HAART)和相应手术的治疗,共随访4~30个月。31例开放手术患者中27例术后恢复良好,4例术后出现艾滋病相关综合征(ARS),其中2例为阴茎癌行阴茎部分切除术,2例为结核性脓肾行肾切除术,复查CD4+T细胞<0.2×109/L,术后4~8个月死于艾滋病。10例腔内手术患者均恢复良好。结论:患者术前通常采用HAART控制病毒的复制。术前CD4+T细胞计数对于确定手术时机及术后处理非常重要,术后应采用CD4+T细胞计数监测病情进展。对于H IV阳性合并泌尿系统疾病需手术处理的患者,应尽可能采用微创手术治疗。同时医护人员在医疗过程中也应重视自身防护以避免职业性感染。     

微波、中药治疗肛周巨大尖锐湿疣27例疗效观察

1999～2002年我院收治肛周巨大尖锐湿疣27例．采用微波及中药治疗，取得较好的疗效，现报告如下。     

HIV感染者和艾滋病患者抑郁状态与社会支持的相关性研究

目的探讨HIV感染者和艾滋病患者（PI。WHA）的抑郁状态与社会支持状况，以及二者之间的相关性。方法采用Zung抑郁自评量表（SDS）、社会支持评定量表（SSRS）对82例PLWHA进行问卷调查。结果PI。WHA的SDS评分（42．81&#177;9．24）分，显著高于常模（P〈0．01）；50例（60．98Yoo）存在抑郁状态；ssRs得分30．06&#177;4．02，显著低于常模（P〈0．01）。PI。WHA抑郁与社会支持呈负相关（均P〈0．01）；婚姻状况、文化程度、感染方式、病程及医疗费用支付方式影响SDS及SSRS得分（P〈0．05，P〈0．01）。结论PI。WHA抑郁发生率高，社会支持水平较低；护理人员应采取有效干预措施提高PLWHA的社会支持水平，以改善其抑郁状态，提高其生活质量。     

农村HIV感染者和AIDS患者应对方式、社会支持及心理健康状况调查分析

目的 了解农村HIV感染者和AIDS患者的应对方式、社会支持、心理健康状况及其相关性.方法 采用医学应对方式问卷(MCMQ)、领悟社会支持问卷(PSSS)及症状自评量表(SCL-90)对94例农村HIV感染者和AIDS患者进行调查分析.结果 MCMQ中面对得分最高(21.70±3.82),回避次之(17.19±3.49),屈服最低(10.36±3.25);PSSS总分为62.50士12.79,呈较高水平;除敌对因子外,SCL-90总分及各因子得分均超过阳性病例筛选分界线;53.3%(52/94)有心理障碍,89.4%(84/94)有轻度心理问题.屈服、回避与心理健康状况呈显著正相关(P＜0.05,P＜0.01),面对和社会支持与心理健康状况无显著相关性(均P＞0.05).结论 农村HIV感染者和AIDS患者采取的主要应对方式为面对,并拥有较好的领悟社会支持,但心理健康水平低下;应予进一步的心理支持,提高其心理健康水平.     

艾滋病及其病毒携带者的心理健康环境与社会支持

基于以人为本的哲学理念。运用社会支持理论，分析了艾滋病／人类免疫缺陷病毒（HIV／AIDS）感染患者的心理健康环境,阐述社会支持的作用，并提出艾滋病患者开展社会支持的具体方法，即大力开展相关知识培训与教育。营造健康的社会环境，进行心理辅导，提供生活援助等。     

艾滋病及其病毒携带者的心理健康环境与社会支持

基于以人为本的哲学理念,运用社会支持理论,分析了艾滋病/人类免疫缺陷病毒(HIV/AIDS)感染患者的心理健康环境,阐述社会支持的作用, 并提出艾滋病患者开展社会支持的具体方法,即大力开展相关知识培训与教育,营造健康的社会环境,进行心理辅导,提供生活援助等.     

Pathology of the breast associated with HIV/AIDS

Breast pathology that is characteristic of patients infected with human immunodeficiency virus (HIV) has not been addressed in the literature. HIV may directly and indirectly affect the glandular, mesenchymal, and intramammary lymphoid tissue in seropositive patients. Likely infections in this setting include tuberculous mastitis and pyogenic abscesses that may lead to fatal septicemia. Benign stromal changes include gynecomastia, adipose tissue deposition as part of the fat maldistribution syndrome, and pseudoangiomatous stromal hyperplasia. Breast carcinoma in HIV-infected patients occurs at a relatively early age, with increased bilateral disease, unusual histology, and early metastatic spread with a poor outcome. However, the link between breast cancer and HIV remains controversial. Kaposi's sarcoma and non-Hodgkin's lymphoma may also be localized to the breast in patients with acquired immunodeficiency syndrome (AIDS). This article reviews benign and malignant breast diseases that are likely to be encountered in patients with HIV/AIDS.     

艾滋病患者症状自评量表简体中文版的信效度检验

目的检验艾滋病患者症状自评简体中文版量表(SSC-HIV-SC)的信效度。方法对繁体中文版SSC-HIV-C进行文字表述调整,对大陆地区302例艾滋病患者进行测试,评价SSC-HIV-SC内部一致性,检验量表的内容效度、结构效度和效标效度。结果 SSC-HIV-SC的内容效度为0.95,主成分法提取11个公因子,累积方差贡献率为57.383%;SSC-HIV-SC总分与研究对象的生活质量量表各维度得分呈负相关(r=-0.202~-0.602,均P0.01);总量表的Cronbach′sα系数为0.913。结论 SSC-HIV-SC具有较好的信度和效度,可作为我国艾滋病患者相关症状的测量工具。     

Women-specific HIV/AIDS services: identifying and defining the components of holistic service delivery for women living with HIV/AIDS

Introduction

The increasing proportion of women living with HIV has evoked calls for tailored services that respond to women''s specific needs. The objective of this investigation was to explore the concept of women-specific HIV/AIDS services to identify and define what key elements underlie this approach to care.

Methods

A comprehensive review was conducted using online databases (CSA Social Service Abstracts, OvidSP, Proquest, Psycinfo, PubMed, CINAHL), augmented with a search for grey literature. In total, 84 articles were retrieved and 30 were included for a full review. Of these 30, 15 were specific to HIV/AIDS, 11 for mental health and addictions and four stemmed from other disciplines.

Results and discussion

The review demonstrated the absence of a consensual definition of women-specific HIV/AIDS services in the literature. We distilled this concept into its defining features and 12 additional dimensions (1) creating an atmosphere of safety, respect and acceptance; (2) facilitating communication and interaction among peers; (3) involving women in the planning, delivery and evaluation of services; (4) providing self-determination opportunities; (5) providing tailored programming for women; (6) facilitating meaningful access to care through the provision of social and supportive services; (7) facilitating access to women-specific and culturally sensitive information; (8) considering family as the unit of intervention; (9) providing multidisciplinary integration and coordination of a comprehensive array of services; (10) meeting women “where they are”; (11) providing gender-, culture- and HIV-sensitive training to health and social care providers; and (12) conducting gendered HIV/AIDS research.

Conclusions

This review highlights that the concept of women-specific HIV/AIDS services is a complex and multidimensional one that has been shaped by diverse theoretical perspectives. Further research is needed to better understand this emerging concept and ultimately assess the effectiveness of women-specific services on HIV-positive women''s health outcomes.     

Depression during the COVID-19 pandemic among people living with HIV: Are low HIV/AIDS stigma and high perceived emotional support protective resources?

This study has two objectives: first, to examine changes in depressive symptoms among people living with HIV (PLWH) during the COVID-19 pandemic and, second, to verify the role of HIV/AIDS stigma and perceived emotional support (PES) in the heterogeneity of these changes. The participants were 392 people with a medical diagnosis of HIV who have undergone antiretroviral therapy. Depression was measured at three time points with 6-month intervals using the Centre for Epidemiological Studies Depression Scale (CES-D). PES was evaluated with the Berlin Social Support Scales, and HIV/AIDS-related stigma was assessed with the Berger HIV Stigma Scale. Latent growth class modelling identified four trajectories of depression over the study period: three stable (very high, high, and very low) and one increasing. Both the very high and high stable trajectories had baseline values above the CES-D cut-off point for depression, suggesting that 57.6% of the sample was likely to be diagnosed with depression. After controlling for sociodemographic and clinical variables, stigma and PES were found to be significant covariates of the obtained trajectories; however, they did not protect against an increase in depression symptoms. There was no overall increase in depression symptoms among the PLWH participants during the pandemic, but this change in depression symptoms was heterogeneous. We observed the potential development of depression in initially well-functioning individuals despite their personal resources differing only slightly from those who remained resilient.     

Pain in people living with HIV/AIDS: a systematic review

Introduction

Pain is one of the most commonly reported symptoms in people living with HIV/AIDS (PLWHA). However, wide ranges of pain prevalence have been reported, making it difficult to determine the relative impact of pain in PLWHA. A systematic review of the literature was conducted to establish the prevalence and characteristics of pain and to explore pain management in PLWHA.

Methods

Studies that included cross-sectional data were included in the search, which was conducted in April 2012. Databases searched using a time limit of March 1982 to March 2012 included PubMed, Scopus, Africa-wide: NIPAD, CINAHL, PsychARTICLES, PSYCINFO, PSYCHIATRYONLINE, ScienceDirect and Web of Science. Search terms selected were “pain” and “HIV” or “acquired immune deficiency syndrome.” Two reviewers independently screened all citation abstracts for inclusion. Methodological quality was evaluated using a standardized 11-item critical appraisal tool.

Results

After full text review, 61 studies fulfilled the inclusion criteria. Prevalence of pain ranged from a point prevalence of 54% (95%CI 51.14–56.09) to 83% (95%CI 76–88) using a three-month recall period. The reported pain was of moderate-to-severe intensity, and pain was reported in one to two and a half different anatomical sites. Moderate levels of pain interference with function were reported. All nine studies reporting on the adequacy of pain management recorded marked under-treatment of pain.

Discussion

The studies reviewed reported that pain commonly presents at multiple pain sites with a range of severity suggesting that there are several differing pathological processes contributing to pain at one time. The interplay of variables associated with pain suggests that the biopsychosocial model of pain is an appropriate paradigm from which to view pain in PLWHA and from which to approach the problem, explore causes and establish effective treatment.

Conclusions

The results highlight that pain is common in PLWHA at all stages of the disease. The prevalence rates for pain in PLWHA do not appear to have diminished over the 30 years spanning the studies reviewed. The body of work available in the literature thus far, while emphasizing the problem of pain, has not had an impact on its management.