艾滋病病毒感染患者围手术期脓毒症的危险因素及治疗研究  

Research on the risk factors of perioperative sepsis for the patients with HIV/AIDS

作　　者：刘保池[1] 王盟[1] 宋言峥[1] 张伟伟[1] 杨昌明[1] 李垒[1] 司炎辉[1] 曹烨[1] 陈辉[1] 

机构地区：[1]上海市公共卫生临床中心外科,201508

出　　处：《中国急救医学》2012年第1期14-17,共4页Chinese Journal of Critical Care Medicine

基　　金：上海市公共卫生临床中心课题（No.KSF0222）

摘　　要：目的探讨艾滋病病毒（HIV）感染患者围手术期脓毒症的危险因素和治疗。方法对2008—10—2010—12在上海市公共卫生临床中心进行手术治疗的144例HIV感染患者进行回顾性分析。根据手术前CD4^＋T淋巴细胞数分为A（0～99个／μL）、B（100～199个／μL）、C（200—349个／μL）、D（≥350个／μL）四组，分别对术前合并普通致病菌、结核杆菌或隐球菌等感染者予以对症治疗，纠正一般情况并控制感染；对合并腹膜炎和深部脓肿的患者，在抗感染治疗的基础上急诊手术。术后监护生命体征，及时处理各种并发症，继续抗感染，营养支持，抗反转录病毒药物和抗结核治疗。结果144例患者中男133例，女11例，平均年龄（42．6±12．5）岁。围手术期脓毒症80例（术前脓毒症14例，术后脓毒症66例），64例无脓毒症发生。术前CD4^＋T淋巴细胞数无脓毒症者（276．97±137．91）个／止显著高于术前脓毒症组（151．29±110．64）个／μL和术后脓毒症组（161．14±128．45）个／μL（F=13．91，P〈0．05）。A、B、C、D四组病例围手术期脓毒症发生率分别为82．6％（19／23）、69．8％（37／53）、40．5％（17／42）和26．9％（7／26），差异有统计学意义（x^2=23．680，P〈0．01）。CD4^＋T淋巴细胞水平与脓毒症发生率呈负相关关系（r=-0．987，P=0．013）。结论随着手术前CD4^＋T淋巴细胞水平的降低，HIV感染患者围手术期脓毒症风险明显增高；全面的手术风险评估和积极的围手术期治疗有望提高合并脓毒症的HIV感染患者手术疗效。Objective To investigate the risk factors and treatment of perioperative sepsis for the patients with HIV/AIDS. Methods Retrospective analysis of 144 HIV - infected patients in Shanghai Public Health Clinical Center from Oct. 2008 to Dec. 2010. The patients were divided into 4 groups based on CD4^＋T cells counts in preoperative period： group A （0 -99 cell/μL）, group B （100 - 199 cell/μL）, group C （200 -349 cell/μL）, group D （≥ 350 cell/μL）. All the patients had standardized surgical procedures, careful surgical process to reduce the operation damage, conventional application of antibiotics, anti - TB, anti - fugal, antiretroviral therapy to prevent infection and promptly treatment of complications. Results Among 144 HIV - infected patients （ male 133 and female 11, aged 42.6 ± 12. 5 ）, 80 patients got perioperative sepsis （ 14 cases in preoperative period and 66 cases in postoperative period）, 64 cases did not get sepsis. The CD4^＋ T cells mean （276.97 ± 137.91 ） cell/μL in preoperative period of patients without sepsis was significant higher than that of patients with perioperative sepsis （151.29 ±110. 64）cell/μL and patients with postoperative sepsis （161. 14 ± 128.45） cell/μL （ F = 13.91, P 〈 0.05 ）. There were statistic differences among A group（ 82.6% ）, B group（69.8% ）, C group （40.5%） and D group （26.9%） （x^2 = 23. 680, P 〈 0. 01 ）. There were negative correlation between the incidence of sepsis and levels of CD4^＋ T cells （ r = - 0. 987, P = 0. 013）. Conclusion With the decrease of CD4^＋T cells counts in preoperative period, the risk of perioperative sepsis had notable increase. Complete evaluation of surgical risk and suitable perioperative treatment may obtain better effect for HIV -infected patients.

关 键 词：人类免疫缺陷病毒 获得性免疫缺陷综合征 脓毒症 外科手术 

分 类 号：R378.2[医药卫生—病原生物学]