血友病合并人类免疫缺陷病毒感染患者的手术安全与护理研究

目的探讨血友病合并人类免疫缺陷病毒(HIV)感染/获得性免疫缺陷综合征(AIDS)患者的围术期治疗和护理措施。方法对14例血友病合并HIV感染者(均为男性,年龄20～54岁)进行手术,术前检测免疫功能,规范手术操作程序,精细操作减少手术损伤,术中持续输注凝血因子Ⅷ,常规应用抗生素预防感染。重视患者的心理护理,用专业性的沟通技巧对患者进行心理疏导,帮助其面对现实,对疾病树立正确的态度,增加生活的信心。结果 6例术后发生脓毒症,经抗生素控制感染和支持治疗后治愈,无手术死亡。脓毒症组术前血清清蛋白(Alb)水平明显低于非脓毒症组,差异有统计学意义(P<0.05)。术后2周复查各项指标,脓毒症组血红蛋白(Hb)明显减少(P=0.047),其他指标差异均无统计学意义(P>0.05)。术前CD4与CD4/CD8,术前CD4与Alb,术前CD4与术后CD4/CD8,术前白细胞计数(WBC)与术后血小板计数(PLT),术后CD4与术前Alb呈正相关(P<0.05)。术前Hb与PLT呈负相关(P<0.05)。术后随访3～35个月,患者均恢复正常生活,心理状态良好,对抗病毒治疗依从性良好。结论对血友病合并HIV感染者采用适当围术期治疗和护理措施可以取得较好的疗效。

Operation Safety and Nursing for Haemophilia Patients with HIV Infection

Objective To probe the perioperative treatment and nursing for haemophilia patients with HIV/AIDS.Methods 14 haemophilia patients with HIV infection(male,aged 20 to 54) were given operation.Immune function of the patients was detected before the operation.Surgical procedures were standardized and the operation was carefully conducted to reduce operation damage.Continuous coagulation factors were infused through the operation.Conventional antibiotics were used to prevent infection.Mentality nursing for the patients was emphasized by using professional communication to encourage the patients to establish right attitude towards the disease and to boost confidence for life.Results 6 patients had sepsis after operation,and they were cured by antibiotics.No patients died of operation.Alb level of the sepsis group was significantly lower than that of the non-sepsis group(P<0.05).In the detection of each indicator of the patients 2 weeks after operation.The level of hematin in pyaemia group was significantly decreased(P=0.047),while the differences of other indicators were not statistically significant(P>0.05).There were positive correaltions between preoperative CD4 and CD4/CD8,preoperative CD4 and albumin,preoperative CD4 and postoperative CD4/CD8,preoperative WBC and postoperative PLT,postoperative CD4 and preoperative albumin(P<0.05).There was negative correlation between preoperative Hb and PLT(P<0.05).Postoperative follow up was carried out for 3 to 35 months,showing that all the patients led a normal life with fine mental status and good compliance with antiviral therapy.Conclusion Suitable perioperative period treatment and nursing may obtain good effect for haemophilia patients with HIV-infected.