Abstract: Objective To observe the changes of immune indexes in HIV patients during limited period orthopedic surgery and analyze the related factors of surgical site infection （SSI） after surgery. Methods from January 2019 to January 2020, 37 patients diagnosed as HIV infection before operation in our hospital and required orthopaedic surgery within the time limit were selected for standardized orthopaedic surgery during the perioperative period. The basic data and immune index changes of patients during the perioperative period were collected, and the fluctuation of immune index changes was analyzed. 9 patients with SSI （24.3%） were included in the infection group, 28 patients （75.7%） without SSI were included in the control group, and the related factors of postoperative SSI were analyzed. Results Among the 37 patients, 12 were newly found HIV infected patients and 25 previously diagnosed HIV patients, of which 16 were not treated with anti retroviral therapy （ART）. One way ANOVA showed that there were significant differences in operation mode, operation time, blood loss, CD4 in 3 days after operation, CD4 in 7 days after operation, CD4 in 14 days after operation, viral load 14 days after operation, Preoperative HCT and HGB, HCT and HGB in 3 days after operation, HCT and HGB in 7 days after operation, HCT and HGB in 14 days after operation, ALB in 7 days after operation and ALB in 14 days after operation between the two groups （P<0.05）. Further Stepwise regression analysis showed that the operation mode had a significant positive impact on the occurrence of SSI （P<0.05）, and HCT in 3 days after operation and CD4 in 14 days after operation had a significant negative impact on the occurrence of SSI （P<0.05）. Conclusion The occurrence of SSI after orthopaedic surgery in HIV patients is affected by many factors, but it is not related to the preoperative viral load and CD4 level, but closely related to the size of surgical trauma, the viral load and CD4 fluctuation during the perioperative period.

Key words: HIV, SSI, surgical incision infection, orthopaedic surgery

摘要： 目的 观察我院HIV患者在限期骨科手术中免疫指标的变化以及术后发生手术部位感染（SSI）的相关因素分析。方法 选取2019年1月至2020年1月在我院术前诊断为HIV感染并需在限期内接受骨科手术的37例患者,在围手术期进行规范骨科手术治疗,收集围手术期的患者基本资料与免疫指标变化资料,分析免疫指标变化的波动,把发生SSI的9例（24.3%）患者纳入感染组,未发生SSI的28例（75.7%）患者纳入对照组,分析术后发生SSI的相关因素。结果 37例患者中,新发现HIV感染患者12例,既往已确诊HIV患者25例,其中未规范接受过抗逆转录病毒疗法（ART）治患者占16例;感染染组与对照组单因素方差分析显示两组间的手术方式、手术时间、出血量、术后3天CD4、术后7天CD4、术后14天CD4、术后14天病毒载量、入院HCT与HGB、术后3天HCT与HGB,7天HCT与HGB,14天HCT与HGB、术后7天ALB,术后14天ALB呈现显著性差异（P<0.05）;进一步行逐步回归分析显示手术方式对是否出现SSI产生显著的正向影响关系（P<0.05）,术后3天HCT、术后14天CD4对是否出现SSI产生显著的负向影响关系（P<0.05）。结论 HIV患者在接受限期骨科手术时,术后发生SSI受多因素影响,但与术前病毒载量及CD4高低无关,与手术创伤大小、围手术期内病毒载量及CD4的波动密切相关。

关键词: HIV, SSI, 手术切口感染, 骨科手术