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Clinical Analysis of 85 Cases of AIDS with Opportunity Infections

目的:进一步认识获得性免疫缺陷综合征（AIDS）并发机会感染的临床特点，提高临床诊断水平，减少误诊。方法:回顾性分析我院85例住院的AIDS患者的临床资料。包括临床表现、常见的机会感染、实验室检查异常情况及机会感染的确诊时间等情况。结果:本组资料中发生机会感染患者主要为青壮年男性，发病后误诊率为70%，大多经两家医院就诊后确诊。60%以上患者首诊于非感染科。临床表现主要有发热、咳嗽、腹泻、消瘦、皮疹、贫血等症状和体征。肺部感染35例（14%），肺结核12例（14%），乙型肝炎9例（10%），丙型肝炎10例（11%），梅毒 7例（8%），耶氏肺孢子菌肺炎（PCP）15例（17%），败血症1例 （1%）。结论:HIV机会感染呈多器官受累，临床表现复杂，不具特异性。临床应提高认识，减少误诊。

Study on the Effectiveness and Problems in Implementing Acquired Immune Deficiency Syndrome Control and Prevention in Community Health Service Centers

ObjectiveTo analyze the effectiveness and problems existing in implementing acquired immune deficiency syndrome (AIDS) control and prevention in community health service centers, and to provide scientific evidence for promoting AIDS control and prevention. MethodsRelated information on AIDS control and prevention in community health service centers in a community in the whole year of 2013 was acquired. The effectiveness and problems existing in case management, laboratory testing and highly active antiretroviral therapy (HAART) based on the current community health service system were analyzed. ResultsBy the end of 2013, the rate of AIDS case management was from zero to 100%, the rate of CD4 T detection was from 76.60% (360/470) to 88.35% (508/575), and the rate of receiving highly active antiretroviral therapy among AIDS patients was from 81.40% (175/215) to 84.41% (287/340). But in the actual work on AIDS in community health service centers, there were still some common problems needing to be solved. ConclusionThe community level management mode of AIDS can promote the accuracy of AIDS patients' information, improve the rate of case management, the rate of CD4 T detection and HAART. It is suggested that the community level management mode of AIDS should be promoted in the cities where AIDS patients are concentrated.

艾滋病并发播散性非结核性分枝杆菌感染一例

Efficacy Analysis of Antiretroviral Therapy in 51 Cases with AIDS

目的:分析艾滋病患者抗病毒治疗后的临床疗效,比较不同基线CD4+T淋巴细胞计数增长情况。方法:纳入51例符合治疗标准的初治患者,采用国家标准抗病毒治疗一线方案和卫生部统一提供的免费药物,通过对服药后半月、1月、3月、6月、12月的时段进行临床评估和实验室检查,并比较不同基线CD4+T淋巴细胞计数水平治疗后的增长情况。结果:治疗12月后,各方案组疗效无差异,不同基线CD4+T淋巴细胞计数的增长有显著差异。毒副反应为肝损伤、过敏性皮疹,消化道反应为主。结论:HAART可显著的抑制体内HIV病毒的复制,重建机体的免疫功能,缓解患者病情,有利于存活期的延长。严重的毒副作用发生较少。

护理本科生对艾滋病相关知识及态度的调查分析

目的　了解护理本科生（护生）对艾滋病（AIDS）相关知识了解情况及对人类免疫缺陷病毒（HIV）感染者/AIDS患者的态度，为学校开展相关健康教育提供参考依据。 方法　2011年2月采用问卷调查法，对285名护生进行调查，收回问卷276份，有效问卷257份。 结果　护生对HIV/AIDS相关知识平均得分为（21.2 ± 3.8）分，对正确使用安全套知识平均得分为（3.7 ± 1.6）分，各年级掌握情况有差异（P＜0.001）。257名护生中，82.5%对因输血或注射感染HIV者持同情态度，33.9%和32.3%的护生对因婚前或婚外性行为、性服务者而感染HIV者持歧视态度。 结论　学校应对护生进行系统正确的HIV/AIDS相关知识的教育，培养护生正确对待HIV感染者/AIDS患者的态度。

艾滋病合并肺结核病患者的影像分析

目的　对艾滋病（AIDS）合并肺结核病患者进行影像学分析，为认识和诊断AIDS合并肺结核提供依据。 方法　回顾分析2008年1月－2011年1月21例确诊AIDS合并肺结核患者（观察组）的临床及影像学资料，并与30例单纯肺结核患者（对照组）对比。 结果　21例AIDS合并肺结核中17例累及2个或以上肺段，14例影像学表现为磨玻璃影，7例伴弥漫粟粒性病灶，8伴肺门和（或）纵隔淋巴结肿大，5例伴有肺外结核；而30例单纯肺结核中，20例仅累及1个肺段，21例影像表现为实变影或斑片影，20例伴有纤维增殖灶，16例有1个或多个空洞；以上影像学特征发生率两组差异有统计学意义。两组胸腔积液发生率差异无统计学意义。 结论　AIDS合并肺结核与单纯肺结核在影像学表现上有明显差别，且具有一定影像学特征，主要表现多种性质的病灶共存、多形态、多叶、段分布，了解其相关临床影像表现特征有利于AIDS并发肺结核的早期诊断和治疗。

Clinicopathological Features of Acquired Immune Deficiency Syndrome Combined with Pneumocystis carinii Pneumonia

ObjectiveTo summarize the clinical, radiological and pathological characteristics of acquired immune deficiency syndrome (AIDS) combined with Pneumocystis carinii pneumonia (PCP), so as to improve the clinicians' understanding of the disease. MethodsThe clinical data of 50 AIDS patients combined with PCP admitted between February 2006 and May 2015 were retrospectively analyzed, including medical history, physical signs, laboratory examination, chest high resolution CT (HRCT), pathological characteristics, treatment and prognosis, etc. ResultsThe clinical features of AIDS patients combined with PCP included cough, dyspnea and fever, without obvious positive signs in the lung.The patients were divided as a mild group, a moderate group and a severe group according to the levels of PaO2.There was significant difference among three groups in serum albumin level [(23±3) g/L vs. (30±5) g/L and (28±6) g/L, P < 0.01].There were no significant differences among three groups in CD4+ T lymphocyte and lactate dehydrogenase (LDH) (P > 0.05).The typical chest radiograph feature of HRCT was ground-glass shadows in both lungs, and may be associated with reticular shadows or "gravel sign" and cyst.Of 50 patients, 16 patients were diagnosed via pathology of transbronchial lung biopsy(TBLB) and only 5 patients were diagnosed via silver staining of the bronchoalveolar lavage fluid (BALF).The other patients were clinically diagnosed.100% of the patients were treated with sulfamethoxazole (SMZco), 64%with caspofungin, and 72% with glucocorticoid.All the patients relieved with no death in hospital. ConclusionWhen a patient got cough, dyspnea and fever, especially ground glass on HRCT in both lungs, AIDS combined with PCP should be highly considered, and diagnostic treatment with SMZco and CD4+ T lymphocyte measurement should be conducted as soon as possible, so as to reduce misdiagnosis and mortality.

A Study on the Effects of Training of Prevention of Occupational Exposure to Blood-borne Pathogens for Medical Staff in High-risk Areas of AIDS

目的　了解艾滋病高发区医务人员血源防护情况以及培训所取得的效果。 方法　采用自行设计的问卷，对凉山州某医院参加培训的职工进行培训前后调查。 结果　培训前89人参加调查，培训后93人参加调查；女性、护士和初级职称者占绝大多数；培训前调查参加者中84.3%接受过预防锐器伤培训，79.8%工作中被锐器刺伤，38.2%报告过职业暴露，95.5%接种过乙肝疫苗；6道知识考核题培训后答对率比培训前均有不同程度的提高，其中4道比较具有统计学上的意义（P＜0.05）。 结论　该院医务人员已具备一定职业防护意识，对一些知识点掌握较好，但培训强化可提高职业暴露报告依从性和预防治疗及时性，更好维护艾滋病高发区医务人员的职业健康。

艾滋病并发眼底病患者的护理

目的　总结艾滋病并发眼底病患者的护理要点。 方法　回顾分析2010年3月－2012年4月艾滋病并发眼底病7例患者（13只眼）的临床资料和护理经验。7例患者中3例放弃手术，4例实施7次手术治疗。护理重点是护理人员的培训和患者的心理护理、局部护理、全身症状护理和健康教育。 结果　艾滋病并发眼底病3例患者放弃手术，4例手术中接受玻璃体切割术者4例次，视网膜修复术2例次，硅油取出术1例次，硅油充填术3例；患者术后视网膜复位4例，术后视力：0.02者2例，数指5例。无1例不良事件和护理安全事件发生，出院随访康复和治疗情况较好。 结论　艾滋病并发眼底病患者的护理重点是眼部和全身疾病的护理、患者的心理护理、隐私保护，以及医护人员的职业防护。

A Survey of Evidence Translation: Getting “HIV/AIDS Clinical Nursing Practice Guideline” into Clinical Practice

ObjectiveTo translate evidence of "HIV/AIDS Clinical Nursing Practice Guideline" into clinical practice, in order to reduce the incidence and severity of symptoms of AIDS and to improve the quality of life of patients. MethodsWe integrated the best evidence into the HIV/AIDS inpatient unit of a tertiary hospital for infectious disease in Shanghai, China between September 2013 and February 2015. Based on the "Ottawa Model of Research Use", this study was divided into four stages: evaluating the status quo, building the evidence-based strategy, applying evidence-based decision-making, and evaluating results and reflecting. 148 patients were either assigned to an intervention group with HIV/AIDS-related symptom management protocol (n=74), or to a usual care group (n=74) for the duration of their antiretroviral therapy. Then Medical Outcomes Questionnaire (MOS-HIV) were applied to evaluate the life quality after intervention. ResultsMixed-effects regression indicated significant difference between groups across time in total MOS-HIV score. The intervention group increased more than the control group 2.72 points in total MOS-HIV scores per month (P<0.05). ConclusionThe evidence-translation and evidence-based decision-making of "HIV/AIDS Clinical Nursing Practice Guideline" can regulate nurse behavior, raise the quality of clinical care and improve the patients' quality of life.