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目的调查骨科HIV感染患者围术期医护人员职业暴露情况,探讨职业防护措施。方法收集2012年1月至2015年12月某医院骨科内固定术或关节置换术围术期76例医务人员艾滋病病毒(HIV)职业暴露信息,调查暴露程度分级、时间分布、暴露类别和部位;在暴露后对相关医务人员进行1年随访,记录预防性服用抗病毒药物治疗情况和发生HIV感染情况。结果 76例职业暴露者中,男性职业暴露比例明显高于女性,<30岁年龄段职业暴露比例明显高于30~45岁和≥46岁年龄段,暴露级别为Ⅰ级的构成比明显高于Ⅱ级、Ⅲ级,从2012年起职业暴露构成比逐年降低,以上指标差异均有统计学意义(均P<0.05)。对暴露类型构成情况分析显示,针刺伤构成比明显高于黏膜溅染,差异有统计学意义(P<0.05);针刺伤中右手暴露构成比明显低于左手,手背暴露构成比明显高于手掌,差异均有统计学意义(均P<0.05);各手指部位暴露情况:食指>中指>小指>拇指>无名指,各手指部位暴露构成比之间差异有统计学意义(P<0.05)。76例职业暴露者中有42例接受预防抗病毒治疗,32例Ⅰ级和Ⅱ级暴露者未坚持完成服药治疗;10例Ⅲ级暴露者坚持全程服药治疗;所有职业暴露者随访期间均未发生HIV感染。结论男性和<30岁的骨科医务工作者是围术期HIV职业暴露的高发人群,针刺伤为主要暴露方式并多发生在左手;围术期严格执行职业暴露防护规范可有效避免暴露后HIV感染。
Objective To investigate occupational exposure of perioperative medical staff in patients with orthopedic HIV infection and to explore occupational protective measures. Methods A total of 76 medical workers were enrolled in this study from January 2012 to December 2015 in a hospital for orthopedics or orthopedic arthroplasty. Occupational exposure data of 76 HIV / AIDS patients were collected. The exposure classification, time distribution, exposure categories and sites were investigated. Relevant medical staffs were followed up for one year after exposure to record the treatment of prophylactic antiretroviral drugs and the occurrence of HIV infection. Results Among the 76 cases of occupational exposure, the occupational exposure was significantly higher in males than in females. The occupational exposure was significantly higher in the 30-year-old group than in the 30-45-year-old group and ≥46-year-old group. The exposure level was significantly higher Ⅱ, Ⅲ grade, from 2012 onwards occupational exposure ratio decreased year by year, the above indicators were statistically significant differences (all P <0.05). Analysis of the composition of the exposure type showed that the constituent ratio of acupuncture wounds was significantly higher than that of mucosal splashes (P <0.05), and the proportion of right-handed exposure in acupuncture injuries was significantly lower than that of left-handed and back-exposed groups (P <0.05). The exposure of each finger site showed that there was a significant difference in exposure composition between the thumb and ring finger (P <0.05) . Of the 76 occupational exposures, 42 received prophylactic antiviral therapy and 32 of grade I and II exposures did not insist on completing the medication; 10 patients with grade III exposures insisted on full course medication; none of occupational exposure occurred during follow-up HIV infection. CONCLUSIONS: Male and <30-year-old orthopedic medical workers are the most frequent perioperative HIV occupational exposures. Acupuncture is the main method of exposure and often occurs in the left hand. Perioperative strict adherence to occupational exposure regulations can effectively prevent post-exposure HIV infection.