HIV感染者胆囊切除围手术期处理

摘要

Objective:To study the surgical risk factors and the perioperative management of cholecystectomy in the HIV infected patients with gallbladder stones. Method:Preoperative routine examination was done for all 20 HIV-infected patients with gallbladder stones and flow cytometry instrument was used to test T-lymphocyte subsets. Sulfamethoxazole and fluconazole were administered only to the patients with CD4<200 cells/µl. for preventing pneumocystis carinii pneumonia and fungal infections. Coagulation factorⅧwas given to the patient with hemophilia. Result:Cholecystectomy was performed on 20 cases under general anesthesia. Five cases occurred with postoperative sepsis, but no mortality. Abnormal results of preoperative tests including CD4、CD4/CD8、hemoglobin and those of postoperative tests including CD4、hemoglobin、albumin were the risk factors of sepsis in HIV-infected patients. Conclusion:The HIV-infected patients are more likely to develop postoperative sepsis. Appropriate management and rational use of antibiotics could help reducing the rate of postoperative infection.%　　目的：研究HIV感染者胆囊结石的手术风险因素和围手术期处理。方法：对20例HIV感染者胆囊结石手术前进行常规检查,用流式细胞仪检测T淋巴细胞亚群,CD4 T淋巴细胞<200 cell/µl者,给予口服SMZ和氟康唑预防肺孢子虫肺炎和真菌感染,对血友病患者围手术期应用凝血Ⅷ因子。结果：20例患者均在全麻下行胆囊切除手术,5例术后发生脓毒症,无手术死亡。发生脓毒症组的术前CD4 T淋巴细胞绝对值、CD4/CD8比值、血色素及术后CD4 T淋巴细胞绝对值、血色素、血清白蛋白水平均明显低于无脓毒症组。结论：对HIV感染合并胆囊结石行胆囊切除有较高的脓毒症发病率,适当的围手术期处理可以取得较好的疗效。