黃朝剛,李 壘,劉保池

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·短篇論著·

HIV感染者圍術(shù)期發(fā)生膿毒癥的臨床特點(diǎn)及烏司他丁治療效果分析

黃朝剛,李 壘,劉保池

HIV；膿毒癥；感染；烏司他丁

黃朝剛,李壘,劉保池.HIV感染者圍術(shù)期發(fā)生膿毒癥的臨床特點(diǎn)及烏司他丁治療效果分析[J].中國(guó)全科醫(yī)學(xué)，2015，18(11)：1330-1332，1336.[www.chinagp.net]

Huang CG,Li L，Liu BC.Clinical characteristics of sepsis of HIV-infected patients in perioperative period and treatment effect of ulinastatin[J].Chinese General Practice，2015，18(11)：1330-1332，1336.

表1 膿毒癥組和非膿毒癥組患者外科疾病構(gòu)成比較〔n(%)〕

表4 烏司他丁亞組與對(duì)照亞組術(shù)前、術(shù)后體溫比較〔℃，M(P25，P75)〕

Table 4 Comparison of preoperative and postoperative body temperature between the ulinastatin group and the control group

組別例數(shù)術(shù)前1天術(shù)后第1天術(shù)后第3天術(shù)后第5天對(duì)照亞組3137.6(37.0,38.3)38.5(38.0,39.0)38.3(38.1,38.7)38.0(37.5,38.3)烏司他丁亞組3137.4(37.1,37.4)38.6(38.4,38.7)37.6(37.2,37.9)37.1(37.0,37.2)U值475.500470.00041.00068.500P值0.9440.881<0.001<0.001

臨床上已有較多關(guān)于烏司他丁治療膿毒癥的報(bào)道，但關(guān)于HIV感染者術(shù)后膿毒癥治療的研究較少。本研究對(duì)上海市公共衛(wèi)生臨床中心外科HIV感染者的圍術(shù)期臨床資料進(jìn)行回顧性分析，探討烏司他丁對(duì)HIV感染者術(shù)后膿毒癥的治療效果。

1 資料與方法

1.1 臨床資料 對(duì)2012年1月—2013年12月上海市公共衛(wèi)生臨床中心外科診治的306例HIV感染者圍術(shù)期的臨床資料進(jìn)行分析?；颊吣?63例、女43例，年齡17～74歲，平均(42.0±12.3)歲?；颊呔诋?dāng)?shù)丶膊】刂婆c預(yù)防中心(CDC)確診為HIV感染，因合并不同的外科疾病需行手術(shù)治療。

2 結(jié)果

2.2 烏司他丁亞組和對(duì)照亞組資料比較 從膿毒癥組患者中隨機(jī)抽取62例，分為烏司他丁亞組(31例)和對(duì)照亞組(31例)。烏司他丁亞組患者在綜合性抗感染治療的基礎(chǔ)上加用烏司他丁治療，20萬(wàn)U，2次/d，靜脈滴注，連用5 d；對(duì)照亞組31例行綜合性抗感染治療。兩亞組患者術(shù)前臨床資料間差異無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05，見表3)。

3 討論

3.1 HIV感染者膿毒癥發(fā)生率 HIV感染者可能合并各種外科疾病需行手術(shù)治療。本研究回顧性分析了2012年1月—2013年12月在上海市公共衛(wèi)生臨床中心行外科治療的HIV感染患者的臨床資料。HIV感染患者由于免疫功能低下，術(shù)后容易發(fā)生膿毒癥[3-4]。Deneve等[5]報(bào)道了11年中對(duì)77例HIV感染者行腹部手術(shù)，術(shù)后感染發(fā)生率為55%，術(shù)后30 d內(nèi)病死率為30%。本研究在2年中306例HIV感染者行手術(shù)治療，術(shù)后膿毒癥發(fā)生率為31.7%；2例術(shù)后30 d內(nèi)死亡，病死率為0.65%；手術(shù)并發(fā)癥和病死率明顯低于有關(guān)報(bào)道[5-7]。

表2 膿毒癥組和非膿毒癥組臨床資料比較〔M(P25，P75)〕

表3 烏司他丁亞組與對(duì)照亞組術(shù)前臨床資料比較〔M(P25，P75)〕

表5 烏司他丁亞組與對(duì)照亞組出院前臨床指標(biāo)比較〔M(P25，P75)〕

HIV感染者合并的機(jī)會(huì)性感染，比普通感染更難控制[8,11-13]。針對(duì)HIV感染患者，在外科手術(shù)清除主要病灶的基礎(chǔ)上，除抗病毒治療、抗結(jié)核或抗真菌治療外，還需一般的抗感染治療(至少1種抗生素)、非特異性抗感染治療及營(yíng)養(yǎng)支持等。外科醫(yī)生需要掌握手術(shù)及圍術(shù)期治療的技巧，縮短HIV感染者住院時(shí)間，減輕患者的病痛及經(jīng)濟(jì)負(fù)擔(dān)。

[1]Levy MM,Fink MP,Marshall JC,et al.2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference[J].Crit Care Med,2003,31(4):1250-1256.

[2]Kedir M.Seroprevalence,pattern and outcome of HIV/AIDS among surgical patients at Gondar University Hospital[J].Ethiop Med J,2008,46(1):15-18.

[3]Jacob ST,Moore CC,Banura P,et al.Severe sepsis in two Ugandan hospitals: a prospective observational study of management and outcomes in a predominantly HIV-1 infected population[J].PLoS One,2009,4(11):e7782.

[4]Stock PG,Barin B,Murphy B,et al.Outcomes of kidney transplantation in HIV-infected recipients[J].N Engl J Med,2010,363(21):2004-2014.

[5]Deneve JL,Shantha JG,Page AJ,et al.CD4count is predictive of outcome in HIV-positive patients undergoing abdominal operations[J].Am J Surg,2010,200(6):694-699.

[6]Owens CD,Stoessel K.Surgical site infections: epidemiology,microbiology and prevention[J].J Hosp Infect,2008,70(Suppl 2):3-10.

[7]Moore CC,Jacob ST,Pinkerton R,et al.Point-of-care lactate testing predicts mortality of severe sepsis in a predominantly HIV type 1-infected patient population in Uganda[J].Clin Infect Dis,2008,46(2):215-222.

[8]Su J,Tsun A,Zhang L,et al.Preoperative risk factors influencing the incidence of postoperative sepsis in human immunodeficiency virus-infected patients: a retrospective cohort study[J].World J Surg,2013,37(4):774-779.

[9]Qin QQ,Wang L,Ding ZW,et al.Situation on HIV/AIDS epidemics among migrant population in China,2008—2011[J].Zhonghua Liu Xing Bing Xue Za Zhi,2013,34(1):41-43.

[10]Deziel DJ,Hyser MJ,Doolas A,et al.Major abdominal operations in acquired immunodeficiency syndrome[J].Am Surg,1990,56(7):445-450.

[11]Zhang L,Liu BC,Zhang XY,et al.Prevention and treatment of surgical site infection in HIV-infected patients[J].BMC Infect Dis,2012,12:115.

[12]Mestres CA,Chuquiure JE,Claramonte X,et al.Long-term results after cardiac surgery in patients infected with the human immunodeficiency virus type-1(HIV-1)[J].Eur J Cardiothorac Surg,2003,23(6):1007-1016.

[13]Okumu G,Makobore P,Kaggwa S,et al.Effect of emergency major abdominal surgery on CD4cell count among HIV positive patients in a sub-Saharan Africa tertiary hospital——a prospective study[J].BMC Surg,2013，13:4.

修回日期：2015-03-10)

(本文編輯：趙躍翠)

Clinical Characteristics of Sepsis of HIV-infected Patients in Perioperative Period and Treatment Effect of Ulinastatin

HUANGChao-gang,LILei，LIUBao-chi.

DepartmentofSurgery,ShanghaiPublicHealthClinicalClinicalClinicalCenter,Shanghai201508,China

Objective To analyse the clinical characteristics of sepsis in HIV-infected patients in the perioperative period and the effect of ulinastatin on the treatment of sepsis.Methods A retrospective study was conducted on the clinical data of 306 HIV-infected patients who received sugical treatment in the Department of Surgery of Shanghai Public Health Clinical Center from January 2012 to December 2013.According to the occurrence of perioperative sepsis，the patients were divided into sepsis group and non-sepsis group.A series of preoperative indicators were reviewed，including immunological indicators(T lymphocytes，T lymphocytes and),white blood cell，hemoglobin and albumin．.In the sepsis group,31 patients who received comprehensive anti-infection treatment combined with ulinastatin were assigned into ulinastatin group and 31 patients who only received comprehensive anti-infection treatment were assigned into control group;the treatment effects of the two groups were compared.Results The incidence of postoperative sepsis was 31.7%(97/306).The sepsis group was lower(P<0.05)than non-sepsis group in preoperative indicators includingT lymphocytes，T lymphocytes，hemoglobin and albumin．The patients in the ulinastatin subgroup had lower (P<0.05) body temperature on day 3 and 5 after operation，compared with the control subgroup; the ulinastatin subgroup was significant different from the control subgroup in the average length of hospital stay 〔( 14.6 ± 2.6) dvs.( 16.2 ± 2.3) d，t = 2.566，P = 0.013〕; either subgroup had one case of death; the two subgroups had no sigficantly difference (P>0.05) in the results ofT lymphocytes，T lymphocytes，，and blood routine reexamination before discharge．Conclusion HIV-infected patients have high incidence of postoperative sepsis. Decrease in preoperative level ofT lymphocytes，，hemoglobin and albumin has correlation with the incidence of postoperative sepsis.Comprehensive anti-infection treatment combined with auxiliary application of ulinastatin may control the systemic inflammatory response and reduce the length of hospital stay.

HIV；Sepsis；Infection；Ulinastatin

201508上海市公共衛(wèi)生臨床中心外科

劉保池，201508上海市公共衛(wèi)生臨床中心外科；E-mail:liubaochi@shaphc.org

R 631

B

10.3969/j.issn.1007-9572.2015.11.025

2014-10-20；