Duane Therèse M, Sekel Susan, Wolfe Luke G, Malhotra Ajai K, Aboutanos Michel B, Ivatury Rao R
Virginia Commonwealth University Medical Center, Richmond, Virginia, USA.
J Trauma. 2008 Jul;65(1):63-5. doi: 10.1097/TA.0b013e318065c02a.
Our goal was to analyze whether the presence of human immunodeficiency virus (HIV) infection effects outcome after trauma.
We performed a retrospective review of trauma patients from 2000 to 2005 comparing HIV-positive patients with HIV-negative patients.
A group of 54 HIV-positive patients were compared with 200 HIV- negative patients who were equally matched for demographics, mechanism, and injury severity. The groups had similar comorbidities except for more coagulopathy (0% vs. 3.7%, p = 0.04) and renal failure (0.5% vs. 9.3%, [p = 0.002]) in the HIV-positive group. The HIV-negative group had 9% overall complications versus 22.2% for the HIV-positive group (p = 0.02). There were more respiratory (0.5% vs. 5.6% [p = 0.03]) and renal (0% vs. 5.6% [p = 0.009]) complications in the HIV-positive group. No differences were found between the groups regarding ventilator, intensive care unit, hospital lengths of stay, or mortality. In the HIV-positive group, 34 had known CD4 counts which averaged 474.6 cells/muL +/- 457.4 cells/muL. There were eight who had a CD4 count less than 200 cells/muL of whom two had complications, and one had an infectious complication. These were not statistically different from those who had CD4 counts >/=200 cells/muL. Regression analysis did not demonstrate any difference in overall complications (p = 0.37) or infections (p = 0.38) regardless of the CD4 count.
Although HIV-infected patients suffer more complications than their noninfected counterparts, HIV does not alter the outcomes for trauma patient. HIV status should not influence management decisions for these patients regardless of the patient's CD4 count.
我们的目标是分析感染人类免疫缺陷病毒（HIV）是否会影响创伤后的结局。
我们对2000年至2005年的创伤患者进行了回顾性研究，将HIV阳性患者与HIV阴性患者进行比较。
一组54例HIV阳性患者与200例HIV阴性患者进行了比较，这些患者在人口统计学、损伤机制和损伤严重程度方面匹配。除了HIV阳性组有更多的凝血功能障碍（0%对3.7%，p = 0.04）和肾衰竭（0.5%对9.3%，[p = 0.002]）外，两组的合并症相似。HIV阴性组的总体并发症发生率为9%，而HIV阳性组为22.2%（p = 0.02）。HIV阳性组有更多的呼吸并发症（0.5%对5.6% [p = 0.03]）和肾脏并发症（0%对5.6% [p = 0.009]）。两组在呼吸机使用、重症监护病房入住时间、住院时间或死亡率方面没有差异。在HIV阳性组中，34例患者已知CD4细胞计数，平均为474.6个细胞/微升±457.4个细胞/微升。有8例患者的CD4细胞计数低于200个细胞/微升，其中2例有并发症，1例有感染性并发症。这些与CD4细胞计数≥200个细胞/微升的患者没有统计学差异。回归分析显示，无论CD4细胞计数如何，总体并发症（p = 0.37）或感染（p = 0.38）均无差异。
虽然HIV感染患者比未感染患者遭受更多并发症，但HIV不会改变创伤患者的结局。无论患者的CD4细胞计数如何，HIV状态都不应影响这些患者的管理决策。
