| Objective(s): To investigate the incidence of HIV associated neurocognitive disorders in HIV/AIDS patients undergoing surgical procedures,And the influencing factors of HIV associated neurocognitive disorders and delirium after general anesthesia,so as to provide reference for early intervention,delay of disease progression and clinical diagnosis and treatment.Methods: A cross-sectional survey method was used to investigate 182 HIV/AIDS inpatients who underwent surgery in Yunnan Infectious Disease Hospital from November 2021 to December 2022 using the MoCA scale and CAM-ICU scale.Demographic data,laboratory test results and clinical diagnosis information were collected through the inpatient medical record system.According to whether they had HIV associated neurocognitive disorders,they were divided into non-HAND group and HAND group,and according to whether they had postoperative delirium,they were divided into non-POD group and POD group.c2,corrected chi-square test,Fisher’s exact probability test,one-way analysis of variance,Welch test and binary Logistic regression analysis were used to test the hypothesis.The epidemiological characteristics and influencing factors of HAND and POD were analyzed with α=0.05 as the critical value of statistical difference.Results:(1)The subjects of this study were 182 HIV/AIDS patients who underwent surgery in Yunnan Infectious Disease Hospital.The prevalence of HAND was 46.15%(84/182),and the incidence of POD was 24.73%(45/182).The gender distribution of 182 patients was mainly male,with 122 males(67.03%)and 60 females(32.97%).The age of the subjects was mainly young and middle-aged,with an average age of(48.81±10.12)years,and the average years of education was(7.75±4.21)years.71.43%(130/182)of the patients were married,mainly physical work,79.67%(145/182)of the patients were engaged in physical work,and the rate of ART treatment was high,96.15%(175/182)of the patients had received standardized ART treatment.(2)Univariate analysis of HAND correlation showed that the occurrence of HAND had statistical significance with age,marital status,years of education,work nature,CD4 cell count and white blood cell count(P<0.05).The mean age of HAND group was(51.94±9.57)years,which was significantly higher than that of non-HAND group(46.13±9.84)years.The average years of education in HAND group(5.86±3.95)was significantly lower than that in non-HAND group(9.37±3.75).In the general characteristics,there was no statistical significance between the occurrence of HAND and gender,body mass index,nationality,drug abuse history,habitual drinking and smoking history,and duration of antiviral treatment(P>0.05).In the part of clinical characteristics: there were statistically significant differences in induction duration and postoperative delirium distribution between the non-HAND and HAND groups(P<0.05),but no statistically significant differences in disease classification,hospital stay,drug discontinuation-eye opening duration(P>0.05).In the MoCA scale,there were statistically significant differences between the non-HAND group and the HAND group in total score,visual space in executive ability,naming,attention,language,abstraction,delayed recall and orientation(P<0.05).In the part of blood routine indexes,there was no statistical significance in the occurrence of HAND and the percentage of neutrophil,lymphocyte,eosinophilic granulocyte,platelet count,hemoglobin count and red blood cell count(P>0.05).In renal function,uric acid,creatinine,urea and HAND had no statistical significance(P>0.05).In liver function,direct bilirubin,indirect bilirubin,total bilirubin,alkaline phosphatase,lactate dehydrogenase,albumin,total protein,aspartate transferase,alanine aminotransferase and HAND had no statistical significance(P>0.05).In the index of lipid metabolism,there was no statistical significance in low density lipoprotein cholesterol,high density lipoprotein cholesterol,total cholesterol,triglyceride and HAND occurrence(P>0.05).In CD4 cells,preoperative electrolyte,inflammation indicators,C-reactive protein,interleukin 6,potassium ion,calcium ion,magnesium ion,phosphorus ion and the occurrence of HAND were not statistically significant(P>0.05).Antiviral therapy,AZT+3TC+EFV/NVP,TDF+3TC+EFV/NVP,AZT+3TC+LPV/r,TDF+3TC+ LPV/r and other programs had no statistical difference in the occurrence of HAND(P>0.05).There was no correlation between ART CPE score and HAND occurrence(P>0.05).(3)The results of multi-factor analysis on HAND showed that age,years of education and white blood cell count were statistically correlated with the occurrence of HAND.The risk of HAND in people over 60 years old was about 13.14 times that in people aged 20-40 years old.The risk of HAND in illiterate people was 16.7 times higher than that in people with 7-12 years of education,and the risk of HAND in illiterate people was 33.3 times higher than that in people with more than 12 years of education.Increased white blood cell count was found to hinder the occurrence of HAND in multiple analysis.(4)POD related univariate analysis results showed that age,smoking history,years of education,marital status,job nature,duration of anesthesia,HAND and POD occurrence had statistical significance(P<0.05).The average age of POD group was(47.51±9.67)years,slightly lower than that of non-POD group(52.78±10.50)years.The average years of education in POD group(5.29±3.67)was lower than that in nonPOD group(8.55±4.08).The average duration of anesthesia in the non-POD group was(115.3±82.6)minutes,significantly lower than that in the POD group(151.2±87.4)minutes.The results of multivariate analysis showed that the increased duration of anesthesia would increase the risk of POD occurrence,and HAND would significantly increase the risk of POD occurrence,which was 25.08 times of the risk of POD occurrence in non-HAND patients.Conclusion(s):(1)The incidence of HIV associated neurocognitive disorders and POD was 46.15% and 24.73% in patients with HIV/AIDS undergoing surgery in Yunnan Infectious Disease Hospital.(2)The main factors that increase the risk of HAND development are old age,low years of education,low white blood cell count.(3)Patients with HAND presence had a significantly higher risk of POD than those without HAND presence.(4)The risk factors for postoperative delirium in HIV/AIDS patients were longer duration of anesthesia and the presence of HAND. |
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