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中华实验和临床感染病杂志(电子版)

中华实验和临床感染病杂志(电子版) ›› 2018, Vol. 12 ›› Issue (05) : 472 -477. doi: 10.3877/cma.j.issn.1674-1358.2018.05.010

所属专题： 文献；

论著

人类免疫缺陷病毒感染/获得性免疫缺陷综合征合并脊柱疾患外科治疗与职业暴露防护策略
孙胜1, 张强1,†(), 赵昌松1, 李鑫1, 赵汝岗1, 张耀1   
  1. 1. 100015　北京，首都医科大学附属地坛医院骨科
  • 收稿日期:2018-02-27 出版日期:2018-10-15
  • 通信作者: 张强
  • 基金资助:
    首都卫生发展科研专项项目(No.首发2018-2-2174); 首都医科大学附属北京地坛医院院内科研基金"育苗计划"项目(No. DTYM201606)

Occupational exposure and protection in perioperative period of patients with human immunodeficiency virus infection/acquired immune deficiency syndrome complicated with spinal surgery

Sheng Sun1, Qiang Zhang1,†(), Changsong Zhao1, Xin Li1, Rugang Zhao1, Yao Zhang1   

  1. 1. Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
  • Received:2018-02-27 Published:2018-10-15
  • Corresponding author: Qiang Zhang
  • About author:
    Corresponding author: Zhang Qiang, Email:
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引用本文：

孙胜, 张强, 赵昌松, 李鑫, 赵汝岗, 张耀. 人类免疫缺陷病毒感染/获得性免疫缺陷综合征合并脊柱疾患外科治疗与职业暴露防护策略[J/OL]. 中华实验和临床感染病杂志(电子版), 2018, 12(05): 472-477.

Sheng Sun, Qiang Zhang, Changsong Zhao, Xin Li, Rugang Zhao, Yao Zhang. Occupational exposure and protection in perioperative period of patients with human immunodeficiency virus infection/acquired immune deficiency syndrome complicated with spinal surgery[J/OL]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2018, 12(05): 472-477.

目的

探讨人类免疫缺陷病毒感染/获得性免疫缺陷综合征(HIV/AIDS)合并脊柱外科疾患围手术期手术治疗与医务人员职业暴露及防护应对措施。

方法

回顾性分析2010年1月至2016年2月首都医科大学附属北京地坛医院收治的需脊柱外科手术治疗的HIV/AIDS患者共56例，其中行颈椎手术者14例，腰椎手术者24例，胸椎手术者10例，椎间盘镜手术者8例。其中有36例脊柱手术围手术期应用数字骨科导航技术。监测入组HIV/AIDS患者行脊柱外科手术过程中医务人员发生职业暴露次数、方式、部位和暴露级别；总结暴露后应对措施及暴露后感染情况。

结果

医务人员发生一级暴露者20例，二级暴露者2例，三级暴露者3例。暴露方式和部位主要以术中针刺伤、黏膜溅染为主，双手是职业暴露发生的主要部位15例(60%)，其次是黏膜喷溅6例次(24%)；左手发生直接暴露者11例(44%)、右手暴露者4例(16%)，但差异无统计学意义(χ2= 0.68、P= 0.56)；各手指部位暴露统计：食指(20%)>拇指(16%)>手掌(12%)>手背(8%)>中指(4%)。经严格按照职业暴露后预防处理原则，无1例医务人员发生HIV感染。

结论

HIV/AIDS患者脊柱外科手术中职业暴露风险不容忽视，围手术期应在遵循骨科手术基本原则的前提下，利用数字骨科导航技术，实施精准定位微创小切口手术，严格执行预防职业暴露相关防护规范化流程，可有效避免医务人员发生职业暴露及暴露后感染。

关键词: 人类免疫缺陷病毒, 脊柱外科, 数字骨科, 手术, 职业暴露, 防护
Objective

To investigate the perioperative treatment of human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) complicated with spinal diseases and the occupational exposure and protective measures of medical personnel.

Method

From January 2010 to February 2016, a total of 56 patients with HIV/AIDS underwent spinal surgery in Beijing Ditan Hospital, Capital Medical University were analyzed, retrospectively, including 14 patients undergoing cervical surgery, 24 patients undergoing lumbar surgery, and 10 patients undergoing thoracic surgery. Discectomy was performed in 8 cases. Digital orthopedic navigation was carried out in 36 cases with spinal surgery. The number, mode, location and level of occupational exposure in all patients with HIV/AIDS during spinal surgery were detected, respectively, and the measures taken and the infection after exposure were summarized.

Result

There were 20 cases of primary exposure, 2 cases of secondary exposure and 3 cases of tertiary exposure. The main exposure patterns and sites were needle puncture and mucosal splashing during operation. A total of 15 cases (60%) were mainly exposed to hands and 6 cases (24%) were mucosal spatter. There were 11 cases (44%) with direct exposure to the left hand and 4 cases (16%) with the right hand, but the difference was not statistically significant (χ2= 0.68,P= 0.56), and the number of finger exposures was index finger (20%) > thumb (16%) > palm (12%) > dorsal hand (8%) > middle finger (4%). According to the principle of prevention and treatment after occupational exposure, none of the medical staff got HIV infection.

Conclusions

Occupational exposure risk in spinal surgery in patients with HIV/AIDS should not be ignored. Under the premise of following, the basic principles of orthopedic surgery in perioperative period, digital orthopedic navigation technology is taken to perform minimally invasive incision surgery. Strict implementation of standardized procedures for prevention of occupational exposure can effectively avoid occupational exposure and post-exposure infection.

Key words: Human immunodeficiency virus, Spinal surgery, Digital orthopaedics, Occupational exposure, Protection
表1 围手术期医务人员职业暴露资料
手术方式 例数 暴露例次数 暴露方式(例次) 构成比(%)
针刺伤 体液飞溅/黏膜溅染
经皮穿刺球囊扩张椎体成形术 4 5 5 0 20.00
导板微创置钉腰椎后路间盘切除减压植骨融合内固定术 11 2 2 0 8.00
微创经椎间孔镜间盘切除术 10 1 1 0 4.00
腰椎后路切开病灶清除减压内固定术 13 9 6 3 36.00
导航下胸椎后路切开复位减压内固定植骨术 4 3 1 2 12.00
颈椎前路椎体次全切减压植骨融合内固定术 10 3 3 0 12.00
颈椎后路椎管扩大成形术 4 2 1 1 8.00
图1 3D打印导板导航技术术中应用
图2 导板导航微创置钉腰椎后路减压椎间融合内固定术术后透视效果验证
图3 2010年至2015年度职业暴露发生例数
表2 医务人员职业暴露方式、处理措施以及随访结果
项目 例次数 构成比(%)
暴露方式 ? ?
? 体液飞溅、黏膜溅染 6 24.00
? 皮肤接触 4 16.00
? 针刺伤 15 60.00
? 拇指(左/右) 4(3/1) 16.00(12/4)
? 食指(左/右) 5(4/1) 20.00(16/4)
? 中指(左/右) 1(1/0) 4.00(4/0)
? 无名指(左/右) 0(0/0) 0.00(0/0)
? 小指(左/右) 0(0/0) 0.00(0/0)
暴露级别 ? ?
? 一级 20 80.00
? 二级 2 8.00
? 三级 3 12.00
处理措施 ? ?
? 局部挤压、流动水冲洗消毒 20 80.00
? 大量生理盐水冲洗眼部黏膜 5 20.00
? 暴露者专家评估及预防用 ? ?
? 药方案执行 19 76.00
预防用药方案 ? ?
? 基本用药 11 44.00
? 强化用药方案 8 32.00
随访1年结果 25 100.00
预防用药时间 ? ?
? < 2 h预防用药 13 52.00
? < 24 h预防用药 2 8.00
? > 48 h用药 4 16.00
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