我国HIV/AIDS患者抗病毒治疗存在的问题与对策

截至2009年底,我国HIV/AIDS人数已达326 000例,其中AIDS患者107 000例,累计死亡54 000例.高效抗反转录病毒疗法（HAART）是目前治疗AIDS最有效的方法,可显著降低HIV/AIDS的病死率.我国自2003年实施免费抗病毒治疗以来,接受免费治疗的人数累计达8万人,病死率已从22.6%降至4%～5%[1],但其间仍面临诸多挑战.     

AIDS患者伤口感染换药的护理

艾滋病（AIDS）的预防、治疗和护理问题是广大医务工作者的重要课题。艾滋病患者机体免疫功能缺陷，常可合并各种致命的机会感染。我院门诊外科换药室2006年5～12月，对9例AIDS致局部组织感染患者换药治疗，护理报告如下。[第一段]     

HIV/AIDS相关性泌尿系统疾病

随着HAART治疗的推广,HIV感染者和AIDS病人的泌尿系统疾病出现了新的特点.本文就HIV/AIDS相关性泌尿系统疾病的流行病学、病因、临床表现及治疗作一综述.     

1例血友病、AIDS合并原发性肝癌患者的护理

对1例血友病甲、AIDS合并原发性肝癌患者实施对症治疗41 d后好转出院.提出在做好消毒隔离和基础护理的基础上,重点加强病情观察、休息及运动指导和对症护理(发热、疼痛、出血等)是促进病情好转的重要措施.     

AIDS合并肝细胞癌临床病理分析

目的 总结AIDS合并肝细胞癌(hepatocellular carcinoma,HCC)病例的临床病理特征。方法 回顾性分析2009年1月至2021年12月首都医科大学附属北京佑安医院诊治的7例AIDS合并HCC患者的临床和病理资料,总结其临床病理特点,并与同期HIV阴性的HCC患者(n=33)做对比分析。结果 7例AIDS合并HCC中,3例共感染HBV,3例共感染HCV,1例合并脂肪性肝病。与HIV阴性HCC患者比较,HIV阳性组共感染HCV多见(P=0.022),肿瘤灶多发(P=0.003),门脉分支侵犯多见(P=0.011);另外,HIV阳性HCC肿瘤低分化,免疫组化高表达GPC3、Ki-67和P53(P=0.024、0.016、<0.001)。结论 AIDS合并HCC患者多共感染HBV或HCV,病理分级高,肿瘤多灶和门脉侵犯常见。对于共感染患者应同时重视基础肝病和抗HIV治疗,规范复查、定期监测。     

1例血友病、AIDS合并原发性肝癌患者的护理

对1例血友病甲、AIDS合并原发性肝癌患者实施对症治疗41d后好转出院。提出在做好消毒隔离和基础护理的基础上，重点加强病情观察、休息及运动指导和对症护理（发热、疼痛、出血等）是促进病情好转的重要措施。     

HIV/AIDS患者鼻出血72例的临床分析

目的分析HIV/AIDS患者鼻出血的临床特征、易发原因,以探讨临床上合适的治疗方法及预防措施。 方法将本院于2010年12月至2017年2月其他科室到耳鼻喉会诊的HIV/AIDS合并鼻出血72例患者作为调查对象,分析疾病特点,总结相关因素,探讨治疗方法及疗效。 结果患者鼻腔黏膜以干燥、溃疡、糜烂或萎缩为主（24例）,其中14例患者鼻腔黏膜水肿,22例患者合并鼻窦炎、鼻前庭炎等相关疾病;出血性质以黏膜破溃、糜烂、水肿等出血为主（37例）,其余患者为动脉出血（21例）及静脉出血（14例）;出血频次以多次为主,> 3次者47例,首次发作者17例,2~3次者8例;出血侧别以双侧为主（43例）,单侧出血者29例。以上各指标采用多个率趋势的卡方检验,差异均具有统计学意义（P均< 0.05）。72例患者中65例出现血常规、凝血功能的异常,70例患者免疫功能下降。经积极治疗后成功治愈者52例、缓解者18例、无效者2例。 结论HIV/AIDS患者鼻出血与其基础疾病相关,临床上采取鼻腔填塞及鼻内镜下微创治疗疗效良好,辅以局部可调式鼻腔冲洗器保湿护理的措施,可较好地预防、恰当地治疗,提高患者的生存质量,减轻痛苦。     

AIDS患者伤口感染换药的护理

艾滋病(AIDS)的预防、治疗和护理问题是广大医务工作者的重要课题.艾滋病患者机体免疫功能缺陷,常可合并各种致命的机会感染[1].我院门诊外科换药室2006年5～12月,对9例AIDS致局部组织感染患者换药治疗,护理报告如下.     

AIDS患者外周血淋巴细胞表面CCR5、CXCR4表达情况分析

目的:研究人免疫缺陷病毒/获得性免疫缺陷综合征(H IV/AIDS)患者淋巴细胞表面第二受体CCR5、CX-CR4的表达情况,分析其临床意义。方法:收集30例H IV/AIDS患者及16例健康对照的抗凝全血,用流式细胞仪检测第二受体CCR5、CXCR4的表达情况,并分析第二受体表达与CD4+T细胞绝对值及T细胞活化(HLA-DR+CD38+)的相关性。结果:AIDS组CD8+T细胞表面CCR5表达明显低于健康对照(P<0.01);AIDS组CD4+T、CD8+T细胞表面CXCR4表达低于健康对照(P<0.01)。H IV/AIDS患者CD4+T、CD8+T细胞表面CCR5、CXCR4的表达与T细胞活化(HLA-DR+)水平明显正相关(P<0.05)。结论:H IV感染者第二受体CCR5、CXCR4的表达与机体对H IV的免疫反应及疾病进展密切相关。     

12例行耳鼻咽喉手术的HIV/AIDS患者临床分析

目的 探讨 HIV/AIDS患者合并需手术治疗的耳鼻咽喉科疾病而行手术治疗的可行性.方法 对12例行耳鼻咽喉科手术的HIV/AIDS患者入院情况、治疗方法 及疗效进行回顾性总结分析.结果 1例患者因血管畸形术中与术后止血失败而死亡,1例患者术后2个月病变复发,余患者术后均恢复良好,生活质量明显提高.结论 对于HIV/AIDS患者合并耳鼻咽喉科需手术疾病,如果各项主要辅助检查结果 正常,在严格掌握手术适应证的情况下可实施手术,可提高患者的生存质量及自信心,延长患者生命.     

Role of interventional radiology in the management of complications after pancreaticoduodenectomy

BACKGROUND: This study evaluated the role of interventional radiology (IR) procedures to manage complications after pancreaticoduodenectomy. METHODS: A retrospective review was made of the records of patients with postsurgical complications managed with IR. RESULTS: Among the 440 patients reviewed, the mortality, morbidity and reoperation rates were 1.6%, 36%, and 2%, respectively. Complications occurred in 159 patients, of which 39 (25%) required > or = 1 IR procedures. Of those 39 patients, 72% underwent percutaneous drainage of an intra-abdominal abscess, 18% underwent percutaneous biliary drainage, and 10% underwent angiography for gastrointestinal bleeding or pseudoaneurysm. The reoperation rate among the 159 patients with complications was 6% (n = 9). Reoperation was avoided in 90% of patients receiving IR. Four patients underwent reoperation despite IR for persistent abscess, pancreatic fistula, anastomotic disruption, or mesenteric venous bleeding. CONCLUSIONS: The majority of complications occurring after pancreaticoduodenectomy can be managed effectively using IR, thus minimizing morbidity and the need for reoperation.     

贞芪扶正胶囊联合高效抗反转录病毒治疗艾滋病的疗效分析

艾滋病是由人类免疫缺陷病毒（HIV）感染,侵犯人体CD4＋T淋巴细胞,破坏人体免疫系统引起的慢性传染病[1].现代医学研究认为,中医药能提高人体免疫功能,改善生活质量.为此,我们采用贞芪扶正胶囊联合高效抗反转录病毒疗法（highly active antiretrovial therapy,HAART）治疗艾滋病,观察中药联合治疗是否具有减毒增效作用,结果报告如下.     

Pancreaticoduodenectomy: Role of interventional radiologists in managing patients and complications

Although the mortality rate after pancreaticoduodenectomy has decreased, the morbidity rate remains high. Major morbidity is often managed with the aid of interventional radiologists. The objective of this study was to evaluate the cooperative roles of interventional radiologists and pancreatic surgeons in complex pancreatic surgery, specifically pancreaticoduodenectomy. Our pancreaticoduodenectomy database was reviewed for all patients undergoing pancreaticoduodenectomy between January 1, 1995 and December 31, 2000. The interventional radiologic procedures for each patient were evaluated. A total of 1061 patients underwent pancreaticoduodenectomy. The overall mortality and morbidity rates were 2.3% and 35%, respectively. Five hundred ninety patients (56%) had no interventional radiologic procedures, whereas 471 patients (44%) had interventional radiologic procedures. Of those, 342 (32%) had preoperative biliary drainage (PBD) and 129 (12%) required postoperative interventional radiologic procedures. Percutaneous aspiration/catheter drainage was required in 84 patients for intra-abdominal abscess, biloma, or lymphocele, with 24 requiring two or more abscess drains. Thirty-nine patients underwent postoperative PBD for bile leaks due to anastomotic disruption, undrained biliary segments, or T-tube/ bile stent dislodgment. Eighteen patients had hemobilia/gastrointestinal bleeding treated by angiography with embolization. The reoperation rate for the entire cohort of 1061 patients was 4.1% (n = 43). Nineteen of the 129 patients (15%) requiring postoperative radiologic intervention required reoperation. Although 4 of 18 patients who required embolization for bleeding subsequently required surgical intervention for the same reason, only 4 of 84 patients undergoing abscess drainage later required operation for anastomotic disruption or unsuccessful percutaneous drainage. As would be expected, the patients who required postoperative radiologic intervention (n = 129) had a higher incidence of postoperative complications including pancreatic fistula (20% vs. 6%, P <0.01), bile leakage (22% vs. 1%, P< 0.01), and wound infection (16% vs. 8%, P < 0.01). With the complications in these 129 patients, the postoperative mortality rate was only 6.2% compared to 1.7% in patients who did not require radiologic intervention (n = 932, P< 0.01). The median postoperative length of stay was 15 days in those patients requiring postoperative radiologic intervention, 10 days in those not requiring intervention (P< 0.01; postoperative interventional radiology vs. no postoperative interventional radiology), and 29.5 days for patients needing reoperation. Interventional radiologists play a critical role in the management of some patients undergoing pancreaticoduodenectomy. Although complications such as anastomotic leaks, abscess formation, and bleeding can result in increased mortality and a longer hospital stay, the skills of the interventional radiology team provide expert management of some life-threatening complications, thus avoiding reoperation, speeding recovery times, and minimizing morbidity. Presented at the Forty-Third Annual Meeting of The Society for Surgery of the Alimentary Tract, San Francisco, California, May 19–22, 2002 (poster presentation).     

HIV感染者术后感染并发症风险因素分析

目的 探讨HIV病人术后发生感染并发症的风险因素及治疗措施。方法 对2009年1月至2010年6月上海市公共卫生临床中心外科收治的97例HIV感染手术病人的临床资料做回顾性分析。结果 手术前后HIV病人血常规、肝肾功能、CD4、CD8、CD4/CD8差异无统计学意义（P<0.05）。CD4<200个/μL病人（A组,51例）33例发生感染性并发症,2例死于脓毒症;CD4 200～350个/μL者（B组,31例）12例发生感染性并发症;CD4＞350 个/μL者（C组,15例）5例发生感染性并发症。A组的感染并发症发生率显著高于B组和C组（P<0.05）。结论 CD4<200个/μL的HIV病人手术后感染并发症发生风险明显增高,应加强围手术期处理。     

The management of surgery in infants and children with the acquired immune deficiency syndrome

Between January of 1981 and June of 1984, 53 infants and children with the diagnosis of AIDS were seen at our institution. Twenty-one of these patients have required 35 operations to determine or administer the proper therapy. We have taken every precaution to minimize the risks of exposure of all health care personnel.     

不同类型Budd-chiari综合征的介入治疗

目的通过342例Budd-chiari综合征的治疗经验,探讨不同类型Budd-chiari综合征的治疗方法。方法利用介入放射的方法对342例不同类型Budd-chiari综合征病变进行相应的介入处理。结果 342例患者,除29例肝静脉完全闭塞患者无法行介入治疗外,其余的均行介入治疗,成功292例,成功率85.4%。2例发生急性心包填塞,经外科处理痊愈,2例发生右侧胸腔出血,经保守治疗吸收好转。其中下腔静脉膜性病变142例均介入治疗成功,成功率100%,阶段性病变65例,介入治疗成功55例,成功率84.6%;肝静脉膜性病变55例,介入治疗全部成功,成功率100%,阶段性闭塞29例,介入治疗成功24例,成功率82.8%,肝静脉完全闭塞29例,未能行介入治疗,成功率0%;下腔静脉膜性病变合并肝静脉膜性病变9例,全部介入治疗成功,下腔静脉阶段病变合并肝静脉阶段病变8例,介入治疗成功5例,成功率62.5%。下腔静脉阶段性闭塞合并肝静脉完全闭塞5例,介入治疗下腔静脉开通成功3例,成功率60%。结论介入治疗是Budd-chiari综合征最有效的治疗方法之一,不同类型Budd-chiari综合征病例应采取不同的方法治疗。     

How interventional radiology changed the practice of a trauma surgeon

Trauma Surgery, with the assistance of advanced technology especially in Imaging (formerly Radiology), enables it to have patient management approaching John Hunter's ideal of treatment by stratagem rather than the "force" of an open operation.     

特殊染色技术在艾滋病合并真菌病理诊断中的应用

目的 探讨特殊染色技术在艾滋病合并真菌病理诊断中的应用价值.方法 选取2010年2月至2013年11月上海市（复旦大学附属）公共卫生临床中心确诊为艾滋病合并真菌感染的患者20例,回顾性分析经苏木素-伊红（HE）染色、过碘酸希夫染色（PAS）和六胺银染色的病理资料,观察常见真菌在光镜下的形态.结果 20例艾滋病合并真菌感染的患者中,肺部隐球菌2例,皮肤、肺、腹腔肠系膜淋巴结马尔尼菲青霉菌3例,会厌、颈部淋巴结、口腔、腹腔及皮肤组织胞浆菌5例,上颌窦、肺及声带曲霉4例（合并结核3例）,肝、咽、食道及胃部白色假丝酵母菌6例.HE染色组织中炎性细胞浸润,可见肉芽肿形成,凝固性坏死,真菌形态尚能辨认,但需仔细观察,否则易漏诊或误诊;PAS染色,真菌孢子和假菌丝呈亮丽的紫红色,细胞核紫蓝色;六胺银染色,真菌孢子和假菌丝呈清晰可辨的黑褐色.结论 除常规进行HE染色外,联合应用PAS染色和六胺银染色,有助于提高真菌的病理诊断率.