HIV/AIDS患者骨科术式、操作方法及防护策略探讨

Operative options, surgical approaches and protection strategies for orthopedic patients with HIV/AIDS

目的探讨HIV/AIDS患者骨科手术方式、操作方法及防护策略,减少手术对机体功能的干扰,降低医务人员发生职业暴露的风险。方法收集2011年9月至2016年11月广州市第八人民医院收治的110例(112次)HIV/AIDS骨科手术患者的临床资料,总结其骨科术式、操作方法及防护策略,观察患者术后HIV/AIDS疾病进展、疼痛症状改善及骨科病情恢复状况,记录术后并发症及医务人员职业暴露发生情况。结果骨科手术术程顺利,术后未有切口感染,也未出现机会性感染和/或恶性肿瘤加重扩散及脏器功能障碍改变,未有医务人员发生职业暴露,术后视觉模拟量表评分较术前明显改善(P<0.05),随访结果表明骨科病情预后良好。结论通过做好术前准备和评估,遵循精准定位、微创切口、规范化操作的手术原则,强调手术操作习惯的改变以及建立职业暴露防护措施,HIV/AIDS骨科手术患者可获得满意的临床疗效,同时起到减少手术并发症、降低职业暴露发生率的作用。

Objective To investigate the operative options,surgical approaches and protection strategies fororthopedic patients with HIV/AIDS,so as to reduce the surgical interference to body functions,and to lower therisks of occupational exposure in medical staff.Methods Clinical data of110(112times)orthopedic patientswith HIV/AIDS who treated in Guangzhou Eighth People's Hospital from September2011to November2016were collected,the operative options,surgical approaches and protection strategies were summarized,postoperative HIV/AIDS progression,improvement of pain symptom,relief of orthopedic diseases were observed,postoperative complications and incidence of occupational exposure in medical staff were recordedsimultaneously.Results All patients underwent orthopedic surgeries smoothly.No surgical site infection,noprogression of opportunistic infection and/or malignant tumor or deteriorated organ dysfunction had happened,also,there was no occupational exposure found in the study.Postoperative visual analogue scale scores wereimproved compared with preoperative ones(P<0.05),and the follow-up results showed good prognosis oforthopedic diseases.Conclusions Orthopedic patients with HIV/AIDS could obtain satisfactory efficacy with lesssurgical complications and lower incidence of occupational exposure through the following strategies,carefulpreoperative preparation and evaluation,strict abidance of surgical principles of precise positioning,minimallyinvasive incision and standard operating,main emphasis on changes of operating habits,as well as theestablishment of protection measures for occupational exposure.