人类免疫缺陷病毒/获得性免疫缺陷综合征患者骨科手术部位感染的影响因素

Influencing factors of orthopedic surgical site infection of patients with human immunodeficiency virus infection/acquired immunodeficiency syndrome

目的研究人类免疫缺陷病毒(HIV)/获得性免疫缺陷综合征(AIDS)患者骨科手术后发生手术部位感染(SSI)的危险因素以及预防策略。方法回顾性分析2010年1月至2018年1月于首都医科大学附属北京地坛医院住院行骨科手术的HIV/AIDS患者共79例,根据是否发生手术部位感染将其分为手术切口感染组(21例)和非感染组(58例)。分析两组患者SSI发生率,筛选SSI影响因素,并经Logistic回归分析确定独立危险因素。结果79例行骨科手术的HIV/AIDS患者中发生SSI者共21例(26.58%),其中13例为切口浅部感染,5例为深部感染,3例为腔隙感染。感染组和非感染组患者年龄基础疾病(糖尿病)、合并疾病(结核)、术前HIV RNA载量、术后1周红细胞沉降率(ESR)、术后1周C-反应蛋白(CRP)、手术时程、住院时间、腰部及下肢手术部位、BMI指数、CD4+T计数、CD8+T计数、CD4+/CD8+T、白细胞(WBC)和血红蛋白(HGB)差异均有统计学意义(P均<0.05)。将临床中及以往文献报道的SSI相关因素均纳入多因素Logistic回归分析,结果显示:年龄、ALB、BMI、CD4+T计数、HGB、WBC、合并疾病(结核)、手术类型、手术部位、手术时程、切口类型、麻醉类型和术中出血量均为HIV/AIDS患者骨科相关手术部位感染的独立危险因素(P均<0.05)。结论行骨科手术的HIV/AIDS患者为SSI高危人群,应针对其危险因素采取有效措施干预,积极治疗基础疾病,纠正贫血、低蛋白血症,合理围手术期用药包括高效联合抗反转录病毒治疗(HAART)进行免疫重建、应用抗菌药物以预防性抗感染治疗;尽量控制术中出血量,减少手术时间,术中严格执行无菌操作,尽可能降低手术切口感染。

Objective To investigate the risk factors and prevention strategies of surgical site infection(SSI)of patients with human immunodeficiency virus(HIV)/acquired immunodeficiency syndrome(AIDS).Methods Total of 79 patients with HIV/AIDS who underwent orthopedic surgery from January 2010 to January 2018 in Beijing Ditan Hospital,Capital Medical University were analyzed,retrospectively.According to whether the infection occurred at operation site,79 cases were divided into infection group(21 cases)and non-infection group(58 cases).The incidence of SSI was analyzed and the influencing factors of SSI were selected and independent risk factors were determined by Logistic regression analysis.Results SSI occurred in 21 cases(26.58%)among the 79 cases with HIV/AIDS undergoing orthopedic surgery,among whom,13 cases were with superficial incision infection,5 cases with deep infection and 3 cases with lacunar infection.Age,basic disease(diabetes),complicated with diseases(tuberculosis),HIV RNA load before operation,erythrocyte sedimentation rate(ESR)one week before operation,C-reactive protein(CRP)one week before operation,operation duration,hospitalization time,waist and lower extremity operation site,body mass index(BMI),CD4+T count,CD8+T count,CD4/CD8+T ratio,white blood cell(WBC)and hemoglobin(HGB)between patients in infection group and non-infection group were all with significant differences(all P<0.05).The SSI related factors in clinical and reported previous literature were included in multivariate Logistic regression analysis.Logistic regression showed that age,ALB,BMI,CD4+T count,HGB,WBC,complicated with diseases(tuberculosis),surgical type,operation location,operation duration,incision type,anaesthesia type and intraoperative bleeding volume were all independent risk factors for orthopedic site infection(all P<0.05).Conclusions Patients with HIV/AIDS who underwent orthopaedic surgery were with high-risk of SSI.Effective measures to intervene in the risk factors should be taken to actively treat the basic diseases,correct the anemia and hypoproteinemia.Reasonable perioperative administrations including highly active anti-retroviral therapy(HAART)for the immune reconstruction,and the application of anti-bacterial drugs is used for the prevention of anti-infection treatment and to control the amount of intraoperative blood loss,shorten the operation time and strictly carry out aseptic operation,in order to reduce the incidence of surgical site infection.