HIV感染者与无HIV感染者脊柱手术切口愈合情况的对比观察

发布时间：2018-06-16 11:40

本文选题：脊柱手术 + 艾滋病　；参考：《中国脊柱脊髓杂志》2017年03期

【摘要】：目的 :比较人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染者与无HIV感染者脊柱手术后手术切口愈合的情况,初步探讨HIV感染者切口愈合不良的影响因素。方法:2011年6月~2015年6月我院手术治疗40例HIV感染的脊柱疾病患者(观察组),选取同时期与观察组性别、年龄、手术方式相匹配的40例无HIV感染的脊柱手术患者作为对照组。记录切口愈合情况,比较观察组和对照组间切口愈合不良(红肿、渗出、血肿、脂肪液化、裂开、感染等)的情况,比较HIV感染者中切口愈合不良患者与切口愈合良好患者间年龄、性别、体质指数(BMI)、白蛋白、HIV感染临床分期、CD4~+T淋巴细胞计数、手术部位、手术入路、手术节段、内固定应用情况、融合情况、手术方式(是否微创手术)、手术时间、术中出血量的差异。结果:观察组患者中,切口愈合良好32例;愈合不良8例,包括切口红肿8例、切口渗出5例、切口裂开1例、切口脂肪液化1例、切口延迟愈合1例,手术部位(切口)感染2例,均为浅表感染,1例细菌培养结果为金黄色葡萄球菌,另1例细菌培养结果阴性。对照组患者中,切口愈合良好39例;愈合不良1例,为浅表感染,细菌培养结果阴性。观察组与对照组患者年龄、性别比、BMI、手术部位、疾病种类、手术方式(是否微创手术)、切口类型、手术入路、手术节段、内固定应用情况、融合情况、手术时间和出血量方面无统计学差异(P0.05)。观察组患者与对照组患者手术部位感染率的差异无统计学意义(P0.05),切口愈合不良的差异有统计学意义(P0.05)。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。HIV感染切口愈合不良患者的CD4~+T淋巴细胞计数、HIV感染临床分期、BMI及血清白蛋白与HIV感染切口愈合良好患者比较有统计学差异(P0.05)。结论:HIV感染者较无HIV感染者更易发生脊柱手术切口愈合不良,且与HIV感染分期C期、CD4~+T淋巴细胞计数200个/μl、BMI和白蛋白较低有关。
[Abstract]:Objective: to compare the wound healing between HIV-infected and non-HIV-infected patients after spinal surgery, and to explore the influencing factors of wound healing in HIV-infected patients. Methods: from June 2011 to June 2015, 40 patients with HIV infected spinal diseases were treated in our hospital. 40 patients without HIV infection were selected as control group. Record the wound healing, compare the bad wound healing (redness, exudation, hematoma, fat liquefaction, split, infection, etc.) between the observation group and the control group, The age, sex, body mass index (BMI), CD4 ~ T lymphocyte count, surgical site, operative approach and operative segment of HIV infected patients with HIV infection were compared between the patients with poor wound healing and those with good wound healing, including age, sex, body mass index (BMI) and clinical stage of HIV infection. Use of internal fixation, fusion, and surgical methods (whether minimally invasive surgery, operative time, intraoperative bleeding volume difference. Results: in the observation group, there were 32 cases of good wound healing, 8 cases of poor healing, including 8 cases of incision redness, 5 cases of incision exudation, 1 case of incision dehiscence, 1 case of incision fat liquefaction, 1 case of delayed wound healing. Surgical site (incision) infection was found in 2 cases, all of which were superficial infection. The result of bacterial culture was Staphylococcus aureus in 1 case, but negative in the other one. In the control group, 39 cases had good wound healing and 1 case had poor healing, the result of bacterial culture was negative. Age, sex ratio, site of operation, type of disease, operation mode (whether minimally invasive operation, incision type, operative approach, operative segment, internal fixation application, fusion) were observed in the observation group and the control group. There was no significant difference in operation time and bleeding volume (P 0.05). There was no significant difference in the infection rate between the patients in the observation group and the patients in the control group (P 0.05), but there was a significant difference in the poor wound healing between the observation group and the control group (P 0.05). All the patients with poor wound healing were treated in time and finally healed, and no delayed infection was found during follow-up. CD4T lymphocyte count in patients with sepsis and dying. HIV infection wound healing. There was significant difference in the clinical stages of HIV infection and BMI and serum albumin in patients with good wound healing of HIV infection. There was significant difference between the patients with HIV infection and the patients with good wound healing (P 0.05). Conclusion Spinal incision healing is more likely to occur in those infected with HIV than those without HIV, and it is related to the lower CD4T lymphocyte count and albumin in stage C of HIV infection.
【作者单位】：首都医科大学附属北京地坛医院骨科;
【基金】：首都临床特色应用研究(No.Z131107002213063) 院内科研基金“育苗计划”项目(DTYM201606) 北京市卫生和计划生育委员会卫生科技成果和适宜技术推广项目(No.TG-2015-05)
【分类号】：R687.3;R512.91

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