摘要
目的:探讨感染性心内膜炎患者的基本临床特征和影响术后早期效果的相关因素。方法:回顾性分析中南大学湘雅医院1981年1月至2019年6月因感染性心内膜炎行手术治疗的患者702例。通过纸质病历和电子病历信息系统收集数据并整理分析。其中,1981年1月至2010年6月的手术患者为早期组,共224例;2010年7月至2019年6月的手术患者为近期组,共478例。采用logistic回归分析术后早期死亡的独立危险因素。结果:702例患者年龄(36.7±16.1)岁,男占68.1%。术前出现卒中者为71例(10.1%),术前进行过透析治疗者为14例(2.0%)。172例患者致病菌为链球菌,占所有血培养阳性结果的59.5%。早期组感染性心内膜炎合并单纯先天性心脏病者的比例明显高于近期组(早期组77例,占34.4%;近期组22例,占4.6%;P<0.05)。术后新发卒中者为15例(2.1%),术后肾功能不全需要透析者为15例(2.1%)。术后30 d内死亡者为29例,病死率为4.1%。Logistic回归分析显示:术后早期死亡的独立危险因素为术前心功能纽约心脏病学会(New York Heart Association,NYHA)分级高(OR=3.22,95%CI:1.50~6.88;P<0.01)、术后脑卒中(OR=5.75,95%CI:1.22~27.07;P<0.05)、术后肾功能不全需要透析(OR=15.53,95%CI:3.50~68.82;P<0.01)、瓣膜周围脓肿(OR=13.19,95%CI:3.83~45.42;P<0.01)和多瓣膜受累(OR=3.57,95%CI:1.24~10.30;P<0.05)。结论:感染性心内膜炎最常见的致病菌为链球菌,手术治疗早期效果满意。术前心功能NYHA分级高、瓣膜周围脓肿、多瓣膜受累、术后肾功能不全需要透析和术后脑卒中是感染性心内膜炎术后早期死亡的独立危险因素。
Objective:To explore the basic clinical characteristics and relevant factors affecting the early postoperative prognosis in patients with infective endocarditis(IE).Methods:A total of 702 patients with IE,who underwent surgery in Xiangya Hospital,Central South University from January 1981 to June 2019,were studied and the data were collected through the paper records and the hospital information system.The patients from January 1981 to June 2010 served as an early group(n=224),and other patients from July 2010 to June 2019 served as a recent group(n=478).Independent risk factors for early postoperative death were determined by logistic regression analysis.Results:The mean age of the 702 patients was 36.7±16.1 years,and the male accounted for 68.1%.Preoperative stroke occurred in 71 patients(10.1%),and dialysis was done in 14 patients(2%)preoperatively.Streptococcus were the pathogenic bacteria in 172 patients,accounting for 59.5%of all positive blood culture results.In the early group,the percentage of IE combined with congenital heart disease was significantly higher than that in the recent group[77 patients(34.4%)in the early group vs 22 patients(4.6%)in the recent group;P<0.05].Postoperative stroke occurred in 15 patients(2.1%),while 59 patients(7%)required new dialysis postoperatively because of renal insufficiency.Twenty-nine patient died in the post-operation,with 4.1%in 30-day mortality.Logistic regression analysis revealed that the high preoperative New York Heart Association(NYHA)grade of cardiac function(OR=3.22,95%CI 1.50-6.88;P<0.01),postoperative stroke(OR=5.75,95%CI 1.22-27.07;P<0.05),postoperative dialysis(OR=15.53,95%CI 3.50-68.82;P<0.01),perivalvular abscess(OR=13.19,95%CI 3.83-45.42;P<0.01)and multivalve involvement(OR=3.57,95%CI 1.24-10.30;P<0.05)were the independent risk factors for early mortality.Conclusion:Streptococcus is the most common pathogenic bacteria in the patients with IE.Surgery for IE can obtain a satisfactory early outcomes.High preoperative NYHA grade of cardiac function,post
作者
凌友鹏
陈旭良
陈迎吉
萨米
罗万俊
LING Youpeng;CHEN Xuliang;CHEN Yingji;SA Mi;LUO Wangjun(Department of Cardiovascular Surgery,Xiangya Hospital,Central South University,Changsha 410008,China)
出处
《中南大学学报（医学版）》
CAS
CSCD
北大核心
2020年第12期1403-1411,共9页
Journal of Central South University ：Medical Science
