血友病HIV感染者的围手术期治疗  

The Perioperativeperiod Treatment for Haemophilia Patients with HIV/AIDS

作　　者：刘保池[1] 刘立[1] 李垒[1] 司炎辉[1] 陈辉[1] 刘新[1] 曹烨[1] 

机构地区：[1]上海市公共卫生临床中心外科,201508

出　　处：《中华全科医学》2011年第3期344-345,355,共3页Chinese Journal of General Practice

基　　金：上海市公共卫生临床中心课题(KSF0222)

摘　　要：目的探讨血友病合并HIV/AIDS感染的围手术治疗措施和手术疗效。方法对9例血友病甲合并HIV感染者(全为男性,年龄20～54岁)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,术前2 h输注凝血Ⅷ因子2 000 U,术中持续输注凝血Ⅷ因子2 000～4 000 U,术后继续应用凝血Ⅷ因子直到伤口愈合。有肝功能障碍者术中还需要输注其它凝血因子。应用抗逆转录病毒药物,应用抗生素预防感染,及时处理并发症。结果 8例手术中无严重的出血,1例合并肝功能障碍术中大出血,用损伤控制技术止血。无手术死亡。一类切口5例,伤口全部一期愈合,三类切口4例,2例伤口感染,2例一期愈合。术后6～12个月随访,患者均恢复良好。结论对血友病合并HIV感染者采用适当围手术期治疗,通过手术去除关键的病变,可以取得较好的疗效。Objective To explore the the perioperativeperiod treatment measure and operative effect for haemophilia patients with HIV/AIDS. Methods 9 cases haemophilia infected with HIV （ male, age 20-54 years old） were investigated. All patients had pre-operative detection of immune function, standardized surgical procedures, careful surgical process to reduce the operation damage,infusion of coagulation factor Ⅷ 2 000 U two hours before operation,2 000-4 000 U during operation, and post-operation infusion of coagulation factor Ⅷ （ with decreasing daily dosage ） were applied until operative incision healed. Other coagulation factors were also applied if liver function abnormal. Applied highly active anti-retroviral therapy（HAART） ,antibiotics were used to prevent infection and promptly treatment of complications. Results There were no abnormal bleeding in 8 patients during operation,damage control technique was used for turbulent bleeding in 1 patient with liver function abnormal. No incision infected in 5 cases of class one incision,2 incision infected in 4 cases of class three incision,no one died of operation. The patients were followed up 6-12 month after operation and all had good resumed. Conclusion Suitable perioperativeperiod treatment and excision of key pathological changes by operation may obtain better effect for haemophilia with HIV-infected patients.

关 键 词：艾滋病 血友病 围手术期 并发症 

分 类 号：R512.91[医药卫生—内科学] R554.11[医药卫生—临床医学]