HIV 感染儿童术后并发症的预测因素。

Predictors of postoperative complications in HIV-infected children undergoing surgery.

机构信息

Department of Pediatric Surgery, Red Cross War Memorial Children's Hospital, School of Child and Adolescent Health, University of Cape Town 7700, South Africa.

Department of Pediatrics and Child Health, Red Cross War Memorial Children's Hospital, School of Child and Adolescent Health, University of Cape Town 7700, South Africa.

出版信息

J Pediatr Surg. 2011 Apr;46(4):674-678. doi: 10.1016/j.jpedsurg.2010.11.026.

DOI:10.1016/j.jpedsurg.2010.11.026

PMID:21496536

Abstract

BACKGROUND

An increasing number of HIV-infected children require a surgical procedure. The aim of this study was to investigate factors associated with the development of complications in HIV-infected children undergoing surgery.

METHODS

A prospective study of HIV-infected children younger than 60 months undergoing surgery at a tertiary referral pediatric hospital from July 2004 to July 2008 was performed. Children were followed postoperatively for the development of complications, length of stay, and mortality.

RESULTS

Eighty-two HIV-infected children, with a median age of 11.5 months (interquartile range, 6-24 months), were enrolled. Most (68; 82.9%) had World Health Organization stage 3 or 4 HIV disease, 72 (88%) had Centers for Disease Control and Prevention stage 2 or 3 disease, and 60 (73%) were taking highly active antiretroviral therapy. Half (41; 50%) were underweight, 37 (45.1%) underwent emergency surgery, 28 (34.2%) required major surgery, and 40 (48.7%) had surgical site contamination at the time of surgery. The median length of hospital stay was 4 days (interquartile range, 2-14 days), and in-hospital mortality was 6 (7%). Thirty-four (42%) children developed 37 complications. On univariate analysis, malnutrition, HIV stage, or type of surgery was not associated with development of complications. In contrast, young age (6 vs 13.5 months; P = .0004), low hemoglobin (9.6 vs 10.5 g/dL; P = .04), or having a major procedure (14 [42%] vs 9 [18%]; P = .03; relative risk, 2.2 [1.2-4.8]) was associated with complications. On logistic regression, younger age (odds ratio = 4.3; P = .004; 95% confidence interval, 1.6-11.9) and major surgery (odds ratio = 6.8; P = .001; 95% confidence interval, 1.5-31.4) were associated with development of a complication.

CONCLUSION

Young age and major surgery were the main predicators of complications in HIV-infected children undergoing surgery.

摘要

背景

越来越多的 HIV 感染儿童需要接受手术。本研究旨在探讨接受手术的 HIV 感染儿童发生并发症的相关因素。

方法

对 2004 年 7 月至 2008 年 7 月在一家三级转诊儿科医院接受手术的 60 个月以下的 HIV 感染儿童进行前瞻性研究。对术后发生并发症、住院时间和死亡率的患儿进行随访。

结果

共纳入 82 例 HIV 感染儿童，中位年龄为 11.5 个月（四分位间距，6-24 个月）。大多数（68 例；82.9%）患有世界卫生组织（WHO）分期 3 或 4 期 HIV 疾病，72 例（88%）患有疾病预防控制中心（CDC）分期 2 或 3 期疾病，60 例（73%）接受高效抗逆转录病毒治疗。半数（41 例；50%）为体重不足，37 例（45.1%）接受急症手术，28 例（34.2%）需要大手术，40 例（48.7%）手术时存在手术部位污染。中位住院时间为 4 天（四分位间距，2-14 天），院内死亡率为 6 例（7%）。34 例（42%）儿童发生 37 种并发症。单因素分析显示，营养不良、HIV 分期或手术类型与并发症的发生无关。相反，年龄较小（6 个月 vs 13.5 个月；P =.0004）、血红蛋白水平较低（9.6 g/dL vs 10.5 g/dL；P =.04）或接受大手术（14 例[42%] vs 9 例[18%]；P =.03；相对风险，2.2[1.2-4.8]）与并发症相关。多因素逻辑回归分析显示，年龄较小（比值比=4.3；P =.004；95%置信区间，1.6-11.9）和大手术（比值比=6.8；P =.001；95%置信区间，1.5-31.4）是发生并发症的主要预测因素。