中华临床医师杂志（电子版）
中華臨床醫師雜誌（電子版）
중화림상의사잡지（전자판）
CHINESE JOURNAL OF CLINICIANS(ELECTRONIC VERSION)
2013年
24期
11325-11328
,共4页
刘保池%冯铁男%黄朝刚%司炎辉%李垒%张伟伟%姜成华
劉保池%馮鐵男%黃朝剛%司炎輝%李壘%張偉偉%薑成華
류보지%풍철남%황조강%사염휘%리루%장위위%강성화
HIV%脓毒症%外科手术%创伤和损伤%感染%肿瘤%功能障碍
HIV%膿毒癥%外科手術%創傷和損傷%感染%腫瘤%功能障礙
HIV%농독증%외과수술%창상화손상%감염%종류%공능장애
HIV%Sepsis%Surgical procedures,operative%Wounds and injuries%Infection%Neoplasms%Dysfunction
目的：探讨HIV感染者需要手术的病种分类及临床特点。方法回顾性分析2009年1月至2013年6月在上海市公共卫生临床中心外科进行手术治疗的484例HIV感染患者（男415例，女69例）。根据患者术后是否发生脓毒症分组，进一步根据手术种类分为创伤，感染，肿瘤和功能障碍分组，分别比较分析脓毒症和无脓毒症患者的手术前CD4、CD8、CD4/CD8、白细胞，血红蛋白，血小板等指标。结果术后共发生脓毒症188例，死亡8例。脓毒症组的CD4数值，CD4/CD8比值明显低于非脓毒症组。创伤组29例，占6%，创伤组术后11例发生脓毒症，脓毒症发病率38%，无死亡；感染组227例，占47%，术后96例发生脓毒症，发病率42%，术后3例死于腹腔感染脓毒症；肿瘤组114例，占23.5%，术后52例发生脓毒症，发病率45.6%，术后5例死于脓毒症；功能障碍组114例，占23.5%。术后29例发生脓毒症，发病率25.4%，术后无死亡。结论 HIV 感染者手术后感染性并发症高，合理围手术期治疗有利于减少术后感染并发症发生率。
目的：探討HIV感染者需要手術的病種分類及臨床特點。方法迴顧性分析2009年1月至2013年6月在上海市公共衛生臨床中心外科進行手術治療的484例HIV感染患者（男415例，女69例）。根據患者術後是否髮生膿毒癥分組，進一步根據手術種類分為創傷，感染，腫瘤和功能障礙分組，分彆比較分析膿毒癥和無膿毒癥患者的手術前CD4、CD8、CD4/CD8、白細胞，血紅蛋白，血小闆等指標。結果術後共髮生膿毒癥188例，死亡8例。膿毒癥組的CD4數值，CD4/CD8比值明顯低于非膿毒癥組。創傷組29例，佔6%，創傷組術後11例髮生膿毒癥，膿毒癥髮病率38%，無死亡；感染組227例，佔47%，術後96例髮生膿毒癥，髮病率42%，術後3例死于腹腔感染膿毒癥；腫瘤組114例，佔23.5%，術後52例髮生膿毒癥，髮病率45.6%，術後5例死于膿毒癥；功能障礙組114例，佔23.5%。術後29例髮生膿毒癥，髮病率25.4%，術後無死亡。結論 HIV 感染者手術後感染性併髮癥高，閤理圍手術期治療有利于減少術後感染併髮癥髮生率。
목적：탐토HIV감염자수요수술적병충분류급림상특점。방법회고성분석2009년1월지2013년6월재상해시공공위생림상중심외과진행수술치료적484례HIV감염환자（남415례，녀69례）。근거환자술후시부발생농독증분조，진일보근거수술충류분위창상，감염，종류화공능장애분조，분별비교분석농독증화무농독증환자적수술전CD4、CD8、CD4/CD8、백세포，혈홍단백，혈소판등지표。결과술후공발생농독증188례，사망8례。농독증조적CD4수치，CD4/CD8비치명현저우비농독증조。창상조29례，점6%，창상조술후11례발생농독증，농독증발병솔38%，무사망；감염조227례，점47%，술후96례발생농독증，발병솔42%，술후3례사우복강감염농독증；종류조114례，점23.5%，술후52례발생농독증，발병솔45.6%，술후5례사우농독증；공능장애조114례，점23.5%。술후29례발생농독증，발병솔25.4%，술후무사망。결론 HIV 감염자수술후감염성병발증고，합리위수술기치료유리우감소술후감염병발증발생솔。
Objective To analyze the classification of surgical diseases and clinical characteristics in HIV-infected surgical patients. Methods Retrospective analysis of 484 HIV-infected patients (male 415, female 69) who have been operated in Surgical Department of Shanghai Public Health Clinical Center from Jan 2009 to June 2013. The patients were divided into postoperative sepsis group and non-sepsis group. Then they were further divided into 4 groups of trauma, infection, tumor and dysfunction in, according to the types of operation. CD4, CD8, CD4/CD8, white blood cell, hemoglobin, platelet and other indicators were compared respectively between sepsis and non-sepsis patients before operation. Results There were 188 patients who got postoperative sepsis and 8 of them died. CD4 counts, CD4/CD8 ratio in sepsis group was significantly lower than the non-sepsis group. There were 29 cases in trauma group, accounting for 6%and 11 cases of postoperative developed sepsis. Septic morbidity rate was 38%(11/29), no mortality occurred. There were 227 cases in infectious group, accounting for 47% and 96 cases of postoperative developed sepsis. Septic morbidity rate was 42%(96/227), 3 cases died of abdominal cavity infection. There were 114 cases in tumor group, accounting for 23.5% and 52 cases of postoperative developed sepsis. Septic morbidity rate was 45.6%(52/114), 5 cases died of sepsis. There were 114 cases in dysfunction group, accounting for 23.5%and 29 cases of postoperative developed sepsis. Septic morbidity rate was 25.4%(29/114), no death. Conclusions HIV-infected patients are more likely to get postoperative infectious complications and rational treatment could help reducing the rate of postoperative infection.
