HIV感染者/AIDS患者外科手术后的临床观察

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。

Clinical observation of HIV/AIDS patients received surgery

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%CI1.8-4.62）, not received antiretroviral treatment（OR=3.02,95%CI1.96-4.22）, HCV coinfected（OR=3.32,95%CI2.10-5.02）, opportunistic infected（OR=2.41,95%CI1.12-4.67）, abnormal liver function（OR=1.91,95%CI1.17-3.10）, and abnormal leukocyte counts（OR=4.94,95%CI3.00-8.43）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.