Nutritional support for human immunodeficiency virus-infected patients during perioperative period / 中华消化外科杂志

ABSTRACT

Objective To investigate the efficacy of nutritional support for human immunodeficiency virus (HIV)-infected and malnutritional patients during perioperative period.Methods The clinical data of 283 HIV-infected patients who were admitted to the Shanghai Public Health Clinical Center from October 2008 to February 2012 were retrospectively analyzed.All patients were divided into malnutritional group and non-malnutritional group according to nutritional condition before operation.Twenty-eight patients with malnutrition (7 patients did not receive perioperative nutritional support due to emergency operation,and they were excluded from the study) and 248 patients in normal nutritional status were enrolled in the study.Nutritional support was given for 5-7 days before operation for patients with malnutrition,and all patients received nutritional support after operation.Differences in the immune function,nutrional status,the incidences of surgical incisional infection and sepsis,and perioperative mortality between the 2 groups were compared.Measurement data were analyzed using the paired t test,and the enumeration data were analyzed using the chi-square test.Results The levels of CD4,CD8 and hemoglobin in patients with malnutrition were (205 ± 24)× 106/L,(559 ± 55)× 106/L and (103 ± 24)g/L after perioperative nutritional support,which were significantly higher than (150 ± 33) × 106/L,(491 ± 45) × 106/L and (97 ± 19)g/L before nutritional support (t =-2.561,-1.302,-1.349,P ＜ 0.05).The levels of CD4,CD8 and hemoglobin were (197 ± 43) × 106/L,(547 ± 52) × 106/L and (103 ± 22) g/L at postoperative day 14,which were decreased compared with those after nutritional support,while no significant difference was detected (t =-1.108,0.600,-0.148,P ＞ 0.05).The incidence of incisional infection in patients with malnutrition was 42.9％ (12/28),which was lower than 45.2％ (112/248) of patients in normal nutritional status,with no significant difference (P ＞0.05).The incidence of postoperative sepsis and perioperative mortality were 75.0％ (21/28)and 3.6％ (1/28) in patients with malnutrition after operation,which were significantly higher than 32.7％ (81/248)and 0.8％ (2/248) in patients in normal nutritional status (P ＜ 0.05).Conclusion The mobidity of HIV-infected patients is high,and nutritional support for HIV-infected patients during perioperative period can improve their immunity.