HIV阳性患者髋关节置换手术切口愈合的临床观察

Clinical observation of surgical incision healing in HIV positive patients with hip replacement

目的比较HIV阳性患者与HIV阴性患者髋关节置换手术后切口愈合情况,探讨炎性指标对HIV感染者术后早期变化的临床意义。方法选取2010年11月—2018年6月在我院行髋关节置换手术治疗的36例HIV感染者(HIV阳性组)为研究对象,纳入同一时期HIV阴性行髋关节置换手术患者共36例(HIV阴性组)作为对照。记录HIV阳性组和HIV阴性组切口愈合情况以及HIV阳性患者CD4+T细胞计数分级,比较2组间切口愈合不良(红肿、渗出、脂肪液化、裂开、流脓等)的情况,并比较HIV阳性组中切口愈合不良与愈合良好患者间早期WBC、ESR、CRP炎性指标的差异。结果HIV阳性组中,切口愈合良好28例,愈合不良8例。HIV阴性组中,切口愈合良好34例,愈合不良2例。HIV阳性组与HIV阴性组患者手术部位感染率比较,差异无统计学意义(P>0.05),而切口愈合不良率比较,差异有统计学意义(P<0.05)。所有切口愈合不良患者给予及时处理后最终均获得愈合,随访无迟发感染、脓毒症及死亡发生。HIV阳性组中,切口愈合不良患者的WBC及CRP水平于术后第3、5、7 d均高于切口愈合良好患者,差异有统计学意义(P均<0.05),ESR水平于术后第5 d高于切口愈合良好患者,差异有统计学意义(P<0.05)。CD4+T细胞计数1、2级HIV阳性患者切口愈合良好和切口愈合不良患者例数比较,差异无统计学意义(P>0.05)。结论通过合理术前评估及加强围手术期处理,HIV阳性患者髋关节置换手术可以取得满意临床疗效。术后WBC、CRP水平对于早期判断切口感染有一定提示作用,对于切口愈合不良并且WBC、CRP水平持续升高者更应加强处理。

Objective To compare surgical incision healing after hip replacement between HIV positive and HIV negative patients,and to explore the clinical significance in inflammatory markers of early changes in HIV-infected patients after operation.Methods Thirty-six HIV-infected patients(HIV positive group)treated with hip replacement in our hospital from November 2010 to June 2018 were included in this study.A total of 36 HIV-negative patients(HIV negative group)undergoing hip replacement at the same time were included as control group.The incision healing in HIV positive and HIV negative groups and the CD4+T cell count grade of HIV positive patients were recorded.Incidence rate of poor healing of the incision(swelling,exudation,fat liquefaction,rupture,suppuration,etc.)between 2 groups were compared.The differences in early inflammatory markers(white blood cell count,ESR,CRP)were compared between patients with poor incision healing and patients with good incision healing in HIV positive group.Results In HIV positive group,28 cases had good incision healing and 8 cases had poor incision healing.In HIV negative group,34 cases had good incision healing and 2 cases had poor incision healing.There was no significant difference in infection rate of surgical site between HIV positive group and HIV negative group(P>0.05),but there were significant differences in the rate of poor incision healing(P<0.05).All patients with poor incision healing were eventually healed after timely treatment.No delayed infection,sepsis and death were observed during follow-up.White blood cell count and CRP levels of patients with poor incision healing were higher than those of patients with good incision healing on Day 3,Day 5 and Day 7 after operation,with statistically significant difference(P<0.05),while ESR on Day 5 after operation was higher than that of patients with good incision healing,with statistically significant difference(P<0.05)in HIV positive group.There was no significant difference in the number of patients with good incision healing and poor incision healing in HIV positive patients with CD4+T cell count grade 1 and 2(P>0.05).Conclusions By reasonable preoperative evaluation and appropriate perioperative treatment,hip replacement in HIV positive patients can achieve satisfactory clinical efficacy.Postoperative white blood cell count and CRP are indicative of early judgment of incision infection.Treatment should be strengthened for patients with poor incision healing and continuous increase of white blood cell count and CRP levels.