HIV感染者围术期发生脓毒症的临床特点及乌司他丁治疗效果分析

Clinical Characteristics of Sepsis of HIV-infected Patients in Perioperative Period and Treatment Effect of Ulinastatin

目的分析HIV感染者围术期发生脓毒症的临床特点及乌司他丁辅助治疗脓毒症的临床效果。方法回顾性分析2012年1月—2013年12月在上海市公共卫生临床中心外科进行手术治疗的306例HIV感染患者的临床资料。根据围术期脓毒症发生情况将患者分为脓毒症组与非脓毒症组,分析两组术前免疫学指标(CD+4、CD+8T淋巴细胞及CD+4T/CD+8T)及白细胞计数、血红蛋白、清蛋白水平。脓毒症组中31例患者在综合性抗感染治疗的基础上辅助应用乌司他丁治疗(乌司他丁亚组),以仅行综合性抗感染治疗患者31例为对照亚组,比较两亚组的治疗效果。结果306例HIV感染患者术后脓毒症发生率为31.7%(97/306)。脓毒症组(n=97)术前CD+4、CD+8T淋巴细胞,CD+4T/CD+8T,术前血红蛋白、清蛋白水平明显低于非脓毒症组(n=209),差异有统计学意义(P<0.05)。乌司他丁亚组治疗3、5 d后体温明显低于对照亚组(P<0.05);两亚组平均住院时间比较,差异有统计学意义〔(14.6±2.6)、(16.2±2.3)d,t=2.566,P=0.013〕;两亚组均有1例死亡;出院时复查CD+4、CD+8T淋巴细胞,CD+4T/CD+8T及血常规,两亚组比较差异无统计学意义(P>0.05)。结论 HIV感染者术后有较高的脓毒症发生率。术前CD+4T淋巴细胞和CD+4T/CD+8T,血红蛋白、清蛋白水平降低与HIV感染者术后脓毒症的发生相关;综合性抗感染治疗辅助应用乌司他丁可以较快控制全身炎症反应,缩短住院时间。

Objective To analyse the clinical characteristics of sepsis in HIV-infected patients in the perioperative period and the effect of ulinastatin on the treatment of sepsis. Methods A retrospective study was conducted on the clinical data of 306 HIV-infected patients who received sugical treatment in the Department of Surgery of Shanghai Public Health Clinical Center from January 2012 to December 2013. According to the occurrence of perioperative sepsis,the patients were divided into sepsis group and non-sepsis group. A series of preoperative indicators were reviewed, including immunological indicators（ CD＋4T lymphocytes,CD＋8T lymphocytes and CD＋4T / CD＋8T）,white blood cell,hemoglobin and albumin. In the sepsis group,31 patients who received comprehensive anti-infection treatment combined with ulinastatin were assigned into ulinastatin group and 31 patients who only received comprehensive anti-infection treatment were assigned into control group; the treatment effects of the two groups were compared. Results The incidence of postoperative sepsis was 31. 7%（ 97 /306）. The sepsis group was lower（ P〈0. 05） than non-sepsis group in preoperative indicators including CD＋4T lymphocytes,CD＋8T lymphocytes,CD＋4T /CD＋8T,hemoglobin and albumin. The patients in the ulinastatin subgroup had lower（ P〈0. 05） body temperature on day 3 and5 after operation,compared with the control subgroup; the ulinastatin subgroup was significant different from the control subgroup in the average length of hospital stay 〔（ 14. 6 ± 2. 6） d vs.（ 16. 2 ± 2. 3） d,t = 2. 566,P = 0. 013〕; either subgroup had one case of death; the two subgroups had no sigficantly difference（ P〈0. 05） in the results of CD＋4T lymphocytes, CD＋8T lymphocytes,CD＋4T / CD＋8T and blood routine reexamination before discharge. Conclusion HIV-infected patients have high incidence of postoperative sepsis. Decrease in preoperative level of CD＋4T lymphocytes,CD＋4T / CD＋8T,hemoglobin and albuminhas correlation with the incidence of postoperative sepsis. Comprehensive anti-infection treatment combined with auxiliary application of ulinastatin may control the systemic inflammatory response and reduce the length of hospital stay.