人类免疫缺陷病毒感染者手术部位感染发生情况分析

Clinical Analysis of Surgical Site Infection in HIV-infected Patients

目的探讨人类免疫缺陷病毒(HIV)感染者手术部位感染的发生情况。方法选取2008年10月—2011年9月在上海市复旦大学附属公共卫生临床中心外科进行手术治疗的HIV感染者242例。根据术前CD4T淋巴细胞计数水平分为A组(≤199 cell/μl)123例、B组(200～349 cell/μl)70例、C组(≥350 cell/μl)49例,比较各组手术部位感染发生率。根据手术切口类型分为Ⅰ、Ⅱ、Ⅲ类切口,比较各类切口手术部位感染发生率。结果 242例HIV感染患者中发生手术部位感染115例(47.5%);其中浅表切口感染93例(38.4%),深部切口感染13例(5.4%),器官或无菌体腔感染9例(3.7%)。4例术后死于腹腔感染脓毒症。A组发生手术部位感染62例(50.4%),B组32例(45.7%),C组21例(42.8%),3组手术部位感染发生率比较差异无统计学意义(χ2=0.344,P>0.05)。Ⅰ类手术切口患者手术部位感染发生率为2.6%(2/77),Ⅱ类66.2%(102/154),Ⅲ类100.0%(11/11),3类手术切口患者手术部位感染发生率比较差异有统计学意义(χ2=96.083,P<0.001)。结论 HIV感染患者手术部位感染发生率较高,术前CD4T淋巴细胞计数不影响手术部位感染率,但是切口类型与手术部位感染率相关,适当的围术期防治措施可减少HIV感染者外科手术部位感染率。

Objective To analyze surgical site infection of patients with HIV infection. Methods 242 HIV - infected patients underwent surgical treatment in Shanghai Public Health Clinical Center Affiliated to Fudan University from October 2008 to September 2011 were divided into group A （CD4 counts≤ 199 cell/μl, 123 cases） , group B （200 〈 CD4 counts 〈 349 cell/μl, 70 cases） and group C （CD4 counts≥350 cell/μl, 49 cases） . The incidence of surgical site infection was compared be- tween the three groups and between three types of incision （ Ⅰ ,Ⅱ and Ⅲ） . Results Among the 242 HIV - infected patients, 115 cases （47. 5% ） had surgical site infection. 93 cases （38.4%） had superficial incision infection, 13 cases （5.4%） had deep incision infection and 9 cases （3.7%） had organ or aseptic coelom infection. 4 cases died of abdomen infection and sep- sis. 62 cases （50.4%） in group A, 32 cases （45.7%） in group B and 21 cases （42. 8% ） in group C had surgical site infec- tion, and the incidence of the three groups showed no statistically significant difference （ χ2 = 0. 344, P 〉 0. 05 ） . The inci- dences of surgical site infection for type Ⅰ,Ⅱ and Ⅲ incisions were 2. 6% （2/77）, 66. 2% （102/154） and 100. 0% （ 11/ 11 ）, and the difference between them was statistically significant （ χ2 = 96. 083, P 〈 0. 001 ） . Conclusion The incidence of surgical site infection is high in HIV - infected patients. Preoperative CD4 counts are not related to the incidence of surgical site in- fection, but the incision type is related to it. Suitable perioperative management can effectively reduce the incidence of surgical site infection in HIV -infected patients.