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

A comparative study on wound healing of spinal incision between HIV infected patients and non HIV infected patients

中文关键词:  脊柱手术  艾滋病  人类免疫缺陷病毒  切口愈合  感染

英文关键词:Spinal incision  Acquired immune deficiency syndrome  Human immunodeficiency virus  Wound healing  Infection

中文摘要:

  【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（P>0.05）。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（P>0.05），切口愈合不良的差异有统计学意义（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。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（P<0.05）。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。

英文摘要:

  【Abstract】 Objectives: To observe and compare the wound healing of spinal incision between human immunodeficiency virus(HIV) infected patients and non HIV infected patients, and to explore the risk factors of poor wound healing in HIV infected patients. Methods: From June 2011 to June 2015, 40 HIV infected patients in our hospital with spinal disorders were enrolled. In the same period, 40 patients with non HIV infected patients were selected as control group matched with the gender, age and operation method. The poor wound healings between HIV infected patients and non HIV infected patients were compared, such as swelling, exudation, rupture, infection, hematoma, fat liquefaction, etc. Age, gender, BMI, albumin, HIV infection clinical stage, CD4+ T cell counts, surgical site, surgical approach, surgical segment, internal fixation, fusion, minimally invasive surgery, operation time and blood loss were compared between poor wound healing and good healing in HIV infected patients. Results: 32 HIV infected patients healed well, while 8 HIV infected patients had poor healing, including 8 incisions of swelling, 5 incisions of exudation, 1 incision of rupture, 1 incision of fat liquefaction, 1 case of delayed healing, 2 incisions of superficial infection, including 1 case of staphylococcus aureus and the other negative. In control group, 39 patients had good healing, while 1 patient had poor wound healing, including 1 superficial infection with negative bacterial culture. There was no significant difference in age, gender, BMI, albumin, HIV infection stage, CD4+ T cell counts, surgical site, surgical approach, surgical segment, internal fixation, fusion, minimally invasive surgery, operation time or blood loss between HIV infected and non HIV infected patients(P>0.05). There was no significant difference in the rate of surgical site infection between HIV infected and HIV infected patients(P>0.05). However, difference in the rate of poor healing was significant(P<0.05). All patients with poor wound healing healed well after timely treatment, without late infection, sepsis or death. CD4+ T cell counts, HIV infection clinical stage, BMI and serum albumin were significantly different between good healings and poor healings in HIV infected patients(P<0.05). Conclusions: HIV infected patients are more likely to have poor wound healing than non HIV infected patients, without significant difference in surgical site infection. HIV infected patients with HIV infection stage C, CD4+ T cell counts less than 200 cells/μl, low BMI and albumin should be paid attention.