普外手术对HIV感染患者临床及免疫学影响  

Clinical and immunological effects of general surgery on HIV infection

作　　者：赵勇 魏国 何永 华欣 蔡琳 何盛华 

机构地区：[1]成都市公共卫生临床医疗中心普通外科,四川成都610061 [2]成都市公共卫生临床医疗中心感染科,四川成都610061

出　　处：《西部医学》2018年第1期59-63,共5页Medical Journal of West China

基　　金：四川省卫生厅科研课题(090013)

摘　　要：目的观察普外手术对人免疫缺陷病毒(Human immunodeficiency virus;HIV))感染不同免疫缺陷程度患者术后感染情况及细胞免疫功能的影响。方法将HIV统计阳性(HIV+组)500例与同期HIV阴性(HIV-组)350例行手术治疗的普外科患者850例,分别观察两组患者术后切口感染、肺部感染、新发机会性感染等指标。并检测其术前1天(D_0)、术后1周(D_7)、术后1月(D_(30))外周静脉血T淋巴细胞亚群CD_4计数;各自计算D_7、D_(30)两次CD_4计数相对于D_0百分比D_7/D_0(%)、D_(30)/D_0(%).并根据D_0的CD_4计数分层(组),Ⅰ≥500>Ⅱ≥200>Ⅲ≥0.采用SPSS18.0软件包分析各组之间及每组内前后差异。结果 HIV+与HIV-两组患者术后感染发生率比较差异有统计学意义(P<0.05),其中HIV+与HIV-两组患者在一、二级手术后感染发生率比较差异无统计学意义(P>0.05),但在三、四级手术后感染发生率比较差异则有统计学意义(P<0.05),在HIV+患者中CD_4>200与CD_4<200术后感染发生率比较差异有统计学意义(P<0.05)。两组内部三次检测CD_4计数两两比较差异有统计学意义(P<0.05);两组之间差异有统计学意义(P<0.05);时间和组别两个因素之间有交互效应(P<0.05)。结论 HIV+组较HIV-组患者术后更易出现感染,且HIV+组患者中手术创伤越大,术后感染并发症越高。因此,术前应全面评价患者的手术适应症,术前可先提高患者免疫力,减少患者术后感染等并发症的发生率,增加治疗的安全性及成功率。Objective To observe the influence of general surgery on infection after operation and immune function.Methods 850 patients with general surgery including 500 cases with positive human immunodeficiency virus and 350 cases with negative human immunodeficiency virus were involved in the present study. The postoperative infection of incision, postoperative pulmonary infection, new indexes of opportunistic infections after surgery were observed. The peripheral blood white blood cell count, neutrophil rate, the rate of lymphocyte and T lymphocyte subsets （CD4, CD8） were observed at 1 day （D0）, 7 day （D7） and 30 days （D30） after operation. Results There were statistically significant differences in the incidence of postoperative infection between HIVinfected patients and nonHIVinfected patients （x2=4097,P〈0.05）. There was no statistically significant difference in the incidence of infection after minor surgery （χ2=0728,P〉0.05）. There was significant difference in the incidence of infection after the operation of the larger operation （χ2=3898,P〈0.05）, in patients with HIV ＋ CD4 〉 200 and CD4 〈 200 postoperative infection rates compare the difference was statistically significant （x2=18793,P〈0.05）. CD4 count before and after each group of three detection of internal differences were pairwise comparison significance （P〈0.05）. Differences between different groups was statistically significant （P〈0.05）. Conclusion HIV infection in patients with nonHIV infection compared with postoperative infection rate are more susceptible to infection. The greater the surgical trauma in HIVinfected patients, the higher the postoperative complications. HIV infection in patients with their own lower immunity, the higher the incidence of postoperative infection. The lower the HIV infection to the patient＇s own immunity, the higher the infection complications. HIV infection in patients under t

关 键 词：人类免疫缺陷病毒 手术 CD4T淋巴细胞 

分 类 号：R730.43[医药卫生—肿瘤]