人类免疫缺陷病毒阳性患者脊柱手术围手术期的处理

Perioperative treatment of patients with human munodeficiency virus undergoing spinal surgery

目的 观察围手术期处理对人类免疫缺陷病毒（HIV）阳性患者脊柱手术并发症的影响,总结有效的围手术期处理方式,使这些患者能够更好地获得治疗.方法 回顾性分析2010年11月到2016年3月48例HIV阳性脊柱手术治疗患者（试验组）,79例HIV阴性脊柱手术治疗患者（对照组）.两组患者在年龄、性别、脊柱手术类型及合并基础病等方面具有可比性.试验组加强营养支持、抗生素的使用、输血等处理,使用免疫调节药物、高效抗逆转录病毒（HAART）治疗,进行职业防护,对照组仅给予常规的围手术期处理.观察两组术后切口愈合情况、机会性感染、内固定失效、死亡等并发症发生情况,并对围手术期处理方法分析总结.率的比较用配对χ2检验,以P〈0.05为差异有统计学意义.结果 试验组及对照组所有患者均顺利完成手术.试验组切口术后延迟愈合2例（4.2%）,对照组切口术后延迟愈合4例（5.1%）,均经过清创后愈合,无切口感染病例.试验组CD4＋T淋巴细胞计数为3级的共2例患者,1例患者进行了急诊手术,术后出现机会性感染,另1例为择期手术的患者,术前将CD4＋T淋巴细胞计数调节为2级后手术,术后无并发症出现.两组均无内固定失效病例及死亡病例.结论 HIV阳性脊柱疾病患者是一类特殊的患者,通过合理术前评估,优化围手术期处理措施及适当手术方式、术后积极防控机会性感染,HIV阳性脊柱手术患者可以减少并发症发生,本组患者均取得良好的临床疗效.

Objective To observe the effect of perioperative treatment on complications in human immunodeficiency virus positive patients undergoing spinal surgery, and summarize effective perioperative management to make these patients to get better treatment. Methods Forty-eight HIV positive patients （experimental group） and 79 HIV negative patients （control group） undergoing spinal surgery from November 2010 to March 2016 were retrospectively reviewed. The two groups were comparable in age, gender, type of spinal surgery and basic diseases. Nutritional support and the uses of antibiotics and blood transfusion were strengthened in patients of experimental group. Immunomodulatory drugs, the treatment with HAART and occupational protection were also used in patients of experimental group. The patients in control group only received conventional perioperative treatment. Wound healing, opportunistic infection, the failure of internal fixation and death after the operation was observed. The perioperative treatment methods were summarized. Chi square test was used in comparison of the rate and P 〈 0.05 was considered statistically significant. Results Surgery was successfully completed in all patients in experimental group and control group. Two cases （4.2%） in experimental group and 4 cases（5.1%） in control group showed delayed healing of incisions. All incisions were healed after debridement and no incision infection happened. CD4＋T lymphocyte count of 2 cases in the experimental group was in stage 3. Among them, 1 patient underwent emergency surgery and opportunistic infection appeared after the operation. The other patients for elective surgery took operation when CD4＋T lymphocyte counts were adjusted to 2 and no complications appeared. The two groups had no internal fixation failure cases and deaths. Conclusions HIV positive patients with spinal diseases are special patients. HIV positive patients with spinal surgery can reduce complications, and achieve good clinical curative effect by reasonable preoperative assessment, optimization of perioperative treatment, proper type of operation and active prevention of opportunistic infections after surgery.