艾滋病患者超长住院时间的影响因素及对策

Risk factors and countermeasures for acquired immunodeficiency syndrome patients hospitalized for more than 30 days

目的分析住院时间超30 d的艾滋病患者临床特征及影响因素,为制定缩短住院日的对策提供依据。方法回顾性分析重庆市公共卫生医疗救治中心感染科2018年1月1日-12月31日连续住院时间超过30 d的艾滋病住院患者,并进行数据整理及分析,探索导致艾滋病患者住院超30 d的危险因素。结果2018年感染科出院艾滋病患者共879例,其中住院超30 d患者124例,占14.1%,男女比例3∶1;124例中住院前未启动抗HIV治疗人数为90例(72.6%),CD4+T细胞<200/L 107例(86.3%),入院时患者病情一般117例(94.4%),危重7例(5.6%)。住院超30 d的艾滋病患者平均住院日为44.7 d。单因素分析显示肝功能损伤、结核病、肺炎、中枢神系统感染、输血、医院感染、营养不良均是影响住院超30 d的危险因素。多因素分析结果显示影响超长住院时间的独立危险因素是中枢神经系统感染。住院超30 d患者1年后的转归较差。结论对于艾滋病患者,做到早发现、早治疗,积极控制机会性感染,缩短平均住院日,降低住院费用,建立健全随访机制,降低死亡率。

Objective To analyze the clinical characteristics and risk factors of acquired immunodeficiency syndrome(AIDS)patients who stayed in hospital for more than 30 days and provide evidence for formulating strategies to shorten the length of hospital stay.Methods The clinical data of AIDS patients who stayed at the Department of Infectious Disease in Chongqing Public Health Medical Center for more than 30 consecutive days from January 1,2018 to December 31,2018 were reviewed and analyzed retrospectively to examine the risk factors for longer hospital stay of AIDS patients.Results A total of 879 AIDS patients were discharged from hospital in 2018,of which 124(14.1%)stayed in hospital for more than 30 days.Male to female ratio was 3:1 in the 124 patients.Most(72.6%,90/124)patients did not start anti-HIV treatment before hospital admission.CD4+T cells<200 cells/μL was found in 107 cases(86.3%).Only 7(5.6%)patients were at critical condition on admission.The average length of hospital stay was 44.7 days.Univariate analysis showed that hepatic impairment,tuberculosis,pneumonia,central nervous system infection,blood transfusion,nosocomial infection and malnutrition were all risk factors for hospital stay≥30 days.Multivariate analysis result showed that central nervous system infection was the independent risk factor for long-term hospital stay.The outcome was poor for the patients who were hospitalized for more than 30 days.Conclusions Opportunistic infections should be detected and treated early for AIDS patients in order to shorten the length of hospital stay,reduce in-hospital cost,and improve follow-up mechanism to reduce mortality.