Albaran R G, Webber J, Steffes C P
Department of Surgery, Wayne State University School of Medicine, Detroit, Mich, USA.
Arch Surg. 1998 Jun;133(6):626-31. doi: 10.1001/archsurg.133.6.626.
To measure the prognostic utility of helper T-cell (CD4) counts in human immunodeficiency virus (HIV)-infected patients undergoing major abdominal surgery.
Retrospective case series.
Three university-affiliated hospitals.
Forty-three HIV-infected patients undergoing major abdominal surgery.
Morbidity and mortality rates with respect to CD4 cell counts.
Nineteen of 32 patients who had CD4 cell counts less than 0.20 X 10(9)/L (200 cells/microL) suffered major complications compared with 2 of 11 patients who had CD4 cell counts greater than 0.20 x 10(9)/L (200 cells/microL) (P=.03). Perioperative mortality was 38% for patients with CD4 cell counts less than 0.20 x 10(9)/L, and was 9% for those with CD4 cell counts greater than 0.20 x 10(9)/L (P=.13). Six months postoperatively, mortality rates were 47% and 9%, respectively (P=.03). Of patients with septic processes perioperatively (n=12), mortality was 75%, and was 19% (P=.009) for those with nonseptic processes (n=31). Nine patients had HIV-related intra-abdominal pathologic conditions at laparotomy. Mortality was 56% perioperatively (P=.13) and 88% after 6 months (P=.001). Sixty-eight percent of patients who received blood product transfusions developed complications, whereas only 7% of those who did not receive transfusions developed complications (P<.001). Overall mortality and morbidity rates were 37% and 49%, respectively. Patients with morbidity had lower CD4 cell counts (median, 0.034 x 10(9)/L) than those without complications (median, 0.102 x 10(9)/L) (P=.02). Similarly, patients who died had lower CD4 cell counts (median, 0.031 x 10(9)/L vs 0.088 x 10(9)/L) (P=.05).
Patients with acquired immunodeficiency syndrome-defining CD4 cell counts undergoing major abdominal surgery developed more complications and had poorer outcomes at 6-month follow-up compared with HIV-infected patients whose CD4 cell counts were greater than 0.20 x 10(9)/L (200 cells/microL). A perioperative septic process and HIV-related pathologic conditions seen at laparotomy are also associated with worse outcomes.
评估辅助性T细胞（CD4）计数对接受腹部大手术的人类免疫缺陷病毒（HIV）感染患者的预后价值。
回顾性病例系列研究。
三家大学附属医院。
43例接受腹部大手术的HIV感染患者。
根据CD4细胞计数得出的发病率和死亡率。
32例CD4细胞计数低于0.20×10⁹/L（200个细胞/微升）的患者中有19例发生了严重并发症，而11例CD4细胞计数高于0.20×10⁹/L（200个细胞/微升）的患者中只有2例发生严重并发症（P = 0.03）。CD4细胞计数低于0.20×10⁹/L的患者围手术期死亡率为38%，而CD4细胞计数高于0.20×10⁹/L的患者围手术期死亡率为9%（P = 0.13）。术后6个月时，死亡率分别为47%和9%（P = 0.03）。围手术期发生脓毒症的患者（n = 12）死亡率为75%，未发生脓毒症的患者（n = 31）死亡率为19%（P = 0.009）。9例患者在剖腹手术时发现有HIV相关的腹腔内病理状况。围手术期死亡率为56%（P = 0.13），6个月后死亡率为88%（P = 0.001）。接受输血的患者中有68%发生了并发症，而未接受输血的患者中只有7%发生了并发症（P < 0.001）。总体死亡率和发病率分别为37%和49%。发生并发症的患者CD4细胞计数（中位数为0.034×10⁹/L）低于未发生并发症的患者（中位数为
