标题:不同麻醉方式致HIV感染期患者术后并发症的临床研究
作者:赵卫兵,龚仕梅,谭容丹,姜海容,徐学文,杨钟平 (重庆市公共卫生医疗救治中心麻醉科,重庆 400036)
卷次:
2018年29卷23期
【摘要】 目的 比较全身麻醉(GA)和腰硬联合麻醉(CSEA)对接受手术的人类免疫缺陷病毒(HIV)感染期患者术后并发症的影响。方法 回顾性分析重庆市公共卫生医疗救治中心2015年1月至2017年12月经确证为HIV阳性,临床分期为无症状感染期的57例患者的临床资料,其中腰硬联合麻醉组21例,全身麻醉组36例。在术前和术后24 h于清晨空腹状态下抽取腰硬联合麻醉组和全身麻醉组患者外周静脉血5~10 mL,进行CD4+和CD8+T淋巴细胞计数。分别记录患者性别、年龄、体质量、患病时长、手术时长、麻醉时间、术后并发症,应用非条件Logistic回归分析HIV感染期患者术后肺部感染并发症的危险因素。结果 全身麻醉组患者麻醉时间为(189.2±107.5) min,明显长于腰硬联合麻醉组的(109.5±68.5) min,肺部感染发生率为33.3%,明显高于腰硬联合麻醉组的9.5%,且两组男性人数均高于女性,差异均有统计学意义(P<0.05);全身麻醉组患者术后与术前24 h外周血CD4+T淋巴细胞计数[(317.7±57.8) % vs (349.7±60.8) %]和CD4+/ CD8+比值[ (0.50±0.11) % vs (0.58±0.18) %]比较,术后均低于术前,术后CD8+T淋巴细胞计数为(597.4±59.6)%,高于术前的(569.2±60.3)%,差异均有统计学意义(P<0.05),而腰硬联合麻醉组患者手术前后上述各项指标比较差异均无统计学意义(P>0.05);对HIV感染期患者术后肺部感染并发症做非条件Logistic回归分析,发现年龄(OR=1.45,95%CI=1.07~2.97,P=0.004)、不同麻醉方式(OR=2.97,95%CI=1.18~10.45,P=0.009)、患病时间(OR=1.17,95%CI=1.04~1.23,P=0.003)是发生术后肺部感染并发症的危险因素。结论 在HIV感染期患者手术中,全身麻醉对术后肺部感染的影响较腰硬联合麻醉显著。
【关键词】 HIV;感染期;并发症;全身麻醉;腰硬联合麻醉
【中图分类号】 R512.91 【文献标识码】 A 【文章编号】 1003—6350(2018)23—3328—04
Clinical study on different anesthetic-induced postoperative complications in patients with HIV infection.
ZHAOWei-bing, GONG Shi-mei, TAN Rong-dan, JIANG Hai-rong, XU Xue-wen, YANG Zhong-ping. Department ofAnesthesiology, Chongqing Public Health Medical Center, Chongqing 400036, CHINA
【Abstract】 Objective To compare the effects of general anesthesia (GA) and combined spinal-epidural anes-thesia (CSEA) on the postoperative complications in patients with human immunodeficiency virus (HIV) infection whounderwent surgery. Methods A retrospective analysis was conducted on clinical data of 57 patients confirmed to beHIV-positive and clinically staged asymptomatic infection in Chongqing Public Health Medical Treatment Center fromJanuary 2015 to December 2017, including 21 patients in combined spinal-epidural anesthesia group and 36 patients ingeneral anesthesia group. Before surgery and 24 hours after surgery, 5-10 mL of peripheral venous blood was taken frompatients in CESA group and GA group in the fasting state in the morning, and CD4+ and CD8+ T lymphocyte counts wereperformed. The patients' gender, age, body weight, duration of illness, length of surgery, anesthesia time, and postopera-tive complications were recorded. Logistic regression analysis was used to analyze the risk factors of postoperative pul-monary infection in HIV infected patients. Results The anesthesia time in the GA group was (189.2±107.5) min, which·论 著·doi:10.3969/j.issn.1003-6350.2018.23.023
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