HIV感染者胆囊切除围手术期处理

Perioperative management of the cholecystectomy in patients with HIV infection

目的:研究HIV感染者胆囊结石的手术风险因素和围手术期处理。方法:对20例HIV感染者胆囊结石手术前进行常规检查,用流式细胞仪检测T淋巴细胞亚群,CD4T淋巴细胞<200cell/μl者,给予口服SMZ和氟康唑预防肺孢子虫肺炎和真菌感染,对血友病患者围手术期应用凝血Ⅷ因子。结果:20例患者均在全麻下行胆囊切除手术,5例术后发生脓毒症,无手术死亡。发生脓毒症组的术前CD4T淋巴细胞绝对值、CD4/CD8比值、血色素及术后CD4T淋巴细胞绝对值、血色素、血清白蛋白水平均明显低于无脓毒症组。结论:对HIV感染合并胆囊结石行胆囊切除有较高的脓毒症发病率,适当的围手术期处理可以取得较好的疗效。

Objective： To study the surgical risk factors and the perioperative management of cholecystectomy in the HIV infected patients with gallbladder stones. Method： Preoperative routine examination was done for all 20 HIV-infected patients with gallbladder stones and flow cytometry instrument was used to test T-lymphocyte subsets. Sulfamethoxazole and fluconazole were administered only to the patients with CD4〈200 cells/μl, for preventing pneumocystis carinii pneumonia and fungal infections. Coagulation factor VHI was given to the patient with hemophilia. Result： Cholecystectomy was performed on 20 cases under general anesthesia. Five cases occurred with postoperative sepsis, but no mortality. Abnormal results of preoperative tests including CD4, CD4/CD8, hemoglobin and those of postoperative tests including CD4, hemoglobin, albumin were the risk factors of sepsis in HIV-infected patients. Conclusion： The HIV-infected patients are more likely to develop postoperative sepsis. Appropriate management and rational use of antibiotics could help reducing the rate of postoperative infection.