Operative risk evaluation and perioperative treatment of haemophilia patients with HIV infection

doi:10.3877/cma.j.issn.2095-9133.2016.04.009

Abstract

Abstract:

Objective

To explore the perioperative risk and treatment methods of HIV-infected patients with hemophilia.

Methods

We detected immune function of 22 HIV-infected patients with hemophilia A (all male, aged 20-54 years old), regulated the operative procedures and operated carefully in order to avoid surgical injury. We also supplemented coagulationⅧ factor, used antibiotics to control infections, and managed complications timely.

Results

There was no intraoperative and postoperative abnormal bleeding in 20 patients. One patient had turbulent bleeding during the surgical removal of the gallbladder. Damage control technology was used to stop the bleeding. Another one patient developed hemorrhagic shock 10 days after operation because of small blood vessel rupture. We transfused blood and supplemented coagulation factors to stop the blooding. All 5 patients with clean wound healed. Two of twelve patients with contaminated wound developed surgical site infections. Four of five patients with dirty wound developed surgical site infections. 9 patients developed sepsis after surgery. Six of the nine patients got infections or sepsis before surgery. There was nobody dead after surgery. All patients were followed up for more than 6 months, and they were all in good condition.

Conclusions

Preoperative infection, intraoperative and postoperative abnormal bleeding are the main reasons of postoperative sepsis for those patients. Using appropriate perioperative treatment for HIV-infected patients with hemophilia can achieve effective results.

Key words: AIDS, hemophilia, operative risk evaluation, complication

Baochi Liu, Lei Li, Yanhui Si, Weiwei Zhang, Xin Liu, Qiling Liu. Operative risk evaluation and perioperative treatment of haemophilia patients with HIV infection[J]. Chinese Journal of Hygiene Rescue(Electronic Edition), 2016, 02(04): 237-241.

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Figures/Tables 4

References 17

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手术类型	例数	术前脓毒症	大出血	术后脓毒症
骨科手术	8	4	0	4
肝胆手术	6	1	1	3
PPH术	5	0	1	1
部分结肠切除术	1	1	0	1
巨大血肿切除术	1	0	0	0
体表肿瘤切除术	1	0	0	0

手术类型	例数	术前脓毒症	大出血	术后脓毒症
骨科手术	8	4	0	4
肝胆手术	6	1	1	3
PPH术	5	0	1	1
部分结肠切除术	1	1	0	1
巨大血肿切除术	1	0	0	0
体表肿瘤切除术	1	0	0	0

组别	例数	年龄(岁)	术前
组别	例数	年龄(岁)	CD4(个/μL)	CD8(个/μL)	CD4/CD8	白细胞计数(×10⁹/L)	血红蛋白(g/L)	血小板计数(×10⁹/L)	白蛋白(g/L)
脓毒症组	9	40.2±8.2	227.8±55.6	634.0±400.3	0.5±0.3	7.2±3.0	116.7±30.3	224.6±133.5	38.2±6.9
非脓毒症组	13	40.5±7.6	480.1±139.3	641.3±337.6	0.75±0.43	8.31±2.46	122.5±53.1	231.9±126.4	45.6±2.9
t值	?	0.077	4.759	0.041	1.500	0.950	0.272	0.115	2.571
P值	?	>0.05	<0.05	>0.05	>0.05	>0.05	>0.05	>0.05	<0.05
组别	例数	年龄(岁)	术后
组别	例数	年龄(岁)	CD4(cell/μL)	CD8(cell/μL)	CD4/CD8	白细胞计数(×10⁹/L)	血红蛋白(g/L)	血小板计数(×10⁹/L)	白蛋白(g/L)
脓毒症组	9	40.2±8.2	211.0±57.3	584.0±340.1	0.5±0.3	6.5±4.8	111.0±22.2	171.3±80.5	36.4±6.4
非脓毒症组	13	40.5±7.6	400.1±118.0	622.2±342.0	0.64±0.2	5.5±2.5	123.1±30.3	223.7±115.3	43.3±3.3
t值	?	0.077	3.531	0.194	1.300	0.578	0.979	1.135	2.493
P值	?	>0.05	<0.05	>0.05	>0.05	>0.05	>0.05	>0.05	<0.05

组别	例数	年龄(岁)	术前
组别	例数	年龄(岁)	CD4(个/μL)	CD8(个/μL)	CD4/CD8	白细胞计数(×10⁹/L)	血红蛋白(g/L)	血小板计数(×10⁹/L)	白蛋白(g/L)
脓毒症组	9	40.2±8.2	227.8±55.6	634.0±400.3	0.5±0.3	7.2±3.0	116.7±30.3	224.6±133.5	38.2±6.9
非脓毒症组	13	40.5±7.6	480.1±139.3	641.3±337.6	0.75±0.43	8.31±2.46	122.5±53.1	231.9±126.4	45.6±2.9
t值	?	0.077	4.759	0.041	1.500	0.950	0.272	0.115	2.571
P值	?	>0.05	<0.05	>0.05	>0.05	>0.05	>0.05	>0.05	<0.05
组别	例数	年龄(岁)	术后
组别	例数	年龄(岁)	CD4(cell/μL)	CD8(cell/μL)	CD4/CD8	白细胞计数(×10⁹/L)	血红蛋白(g/L)	血小板计数(×10⁹/L)	白蛋白(g/L)
脓毒症组	9	40.2±8.2	211.0±57.3	584.0±340.1	0.5±0.3	6.5±4.8	111.0±22.2	171.3±80.5	36.4±6.4
非脓毒症组	13	40.5±7.6	400.1±118.0	622.2±342.0	0.64±0.2	5.5±2.5	123.1±30.3	223.7±115.3	43.3±3.3
t值	?	0.077	3.531	0.194	1.300	0.578	0.979	1.135	2.493
P值	?	>0.05	<0.05	>0.05	>0.05	>0.05	>0.05	>0.05	<0.05

项目	清洁切口	污染切口	感染切口
手术部位感染	0	2	4
无手术部位感染	5	10	1

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