人类免疫缺陷病毒感染者手术部位感染相关因素分析

Analysis of relevant factors of surgical site infection in patients with human immuno-deficiency virus infection

目的分析人类免疫缺陷病毒(HIV)感染的手术患者手术部位感染的相关因素。方法回顾2011年1月-2019年7月收治的161例HIV感染手术患者的临床资料,对其发生手术部位感染的相关因素进行单因素与多因素分析。结果单因素分析结果显示,BMI值(>24.5或<18.5 kg/m^2)、病程(≥5年)、切口分类(Ⅲ或Ⅳ)、手术时间(≥30 min)、出血量(≥100 mL)、切口大小(≥5 cm)、血浆病毒载量(≥10000 copies/mL)、CD4^+T淋巴细胞计数(<500个/mm^3)、血清白蛋白浓度(<30 g/L)、血红蛋白浓度(≤90 g/L)等7个因素是HIV感染手术患者手术部位感染的危险因素(P<0.05);多因素分析显示,CD4^+T淋巴细胞计数(<500个/mm^3)、切口大小(≥5 cm)、切口分类(Ⅲ或Ⅳ)等是HIV感染手术患者手术部位感染的独立危险因素,而术中合理预防使用抗菌药物与规范抗病毒治疗史是独立保护因素(P<0.05)。结论规范抗病毒治疗,抑制CD4^+T淋巴细胞降低,采用微创手术方式,术中规范预防使用抗菌药物,减少不必要的感染或污染等可减少HIV感染手术患者手术部位感染的发生。

Objective To analyze the relevant influencing factors of surgical site infection in surgical patients with human immunodeficiency virus(HIV)infection.Methods The clinical data of 161 HIV-infected surgical patients admitted from January 2011 to July 2019 were reviewed,and the factors related to the surgical site infection were analyzed by univariate and multivariate analysis.Results Univariate analysis showed that 7 factors such as BMI value(>24.5 or<18.5 kg/m^2),course of disease(≥5 years),incision classification(Ⅲ or Ⅳ),operation time(≥30 min),amount of bleeding(≥100 mL),incision size(≥5 cm),plasma viral load(≥10000 copies/mL),CD4^+ T lymphocyte count(<500/mm^3),serum albumin concentration(<30 g/L)and hemoglobin concentration(≤90 g/L)were risk factors for surgical site infection in HIV-infected surgical patients(P<0.05).Multivariate analysis showed that CD4^+ T lymphocyte count(<500/mm^3),incision size(≥5 cm)and incision classification(Ⅲ or Ⅳ)were independent risk factors for surgical site infection in HIV-infected patients.Rational use of antibiotics during surgery and the history of standardized antiviral therapy were independent protective factors.Conclusion Standardized antiviral therapy,inhibition of CD4^+ T lymphocyte reduction,minimally invasive surgery,standardized use of antibiotics during surgery,and reducing unnecessary infection or contaminated surgery can reduce the incidence of surgical site infection in HIV-infected patients.