早期手术治疗感染性心内膜炎的可行性探讨  

Clinical analysis of early surgical operation in infective endocarditis

作　　者：贾立群[1] 付强[1] 杨帅[1] 梁德刚[1] 吕星[2] 魏民新[1] 

机构地区：[1]天津医科大学总医院心血管外科,300052 [2]天津医科大学总医院感染免疫科,300052

出　　处：《中华胸心血管外科杂志》2012年第8期464-466,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的探讨早期手术治疗感染性心内膜炎（IE）的可行性。方法1996年6月至2011年7月，135例IE患者接受手术治疗。分为A组（早期手术治疗组，2008年后收治的患者）和B组（传统治疗组，2008年前收治的患者）。比较两组患者死亡、治疗后心功能不全、感染复发、出院后栓塞等事件，分析患者生存情况。结果两组患者一般资料无差异。组间比较，A组患者整体死亡比例下降（9．4％对23．0％，P=0．016）；心脏功能衰竭患营比例减少（5．4％对26．2％，P〈0．001）；两组患者感染复发比例无差异（0对4．9％，P=0．112；）。A组患者手术比例高（67．6％对32．8％，／9〈0．001），手术死亡率及冉感染发生率未增加（6．0％对15．0％，P=0．222；0对5．0％，P=0．405）。结论早期积极合理的外科治疗町以改善IE患者擎体预后。Objective The surgery time for patients with intective endocarditis （IE） has been transformed. It has been supported that, for the patients with surgical indications, the surgery time should be as early as possible to improve the clinical outcome. The purpose of the research is to identity whether the patients with RE could get further benefit from early surgery. Methods Between June 1996 and July 2011, 135 IE patients＇data has been collected retrospectively, all of whom were veri- fied through the modifcd Duke categories. The patients were derided into group A（ the new therapeutic schedule group after 2008 ） and group B（ the traditional therapeutic schedule group before 2008） by the year of 2008. The end points of observation were death associated with IE, cardiac failure, embolism, and re-infection. The comparison between the groups was by means of non-parameter rank and inspection test, variance analysis, t-test, chi-square test, fsher exact test. The outcome comparison between the groups was via the Kaplan-Meier survival analysis. Results There were no significant differences in baseline data between the groups. No survival differences could be observed via the Kaplan-Meier analysis（ Log Rank P = 0. 189）. During the fi^llowing-up visit, t：ompared with the patients in group B, the mortality in group A is lower（9.4% vs. 23.0% , P = 0. 016） , the incidence of heart failure, was less in group A （5.4% vs. 26.2%, P 〈0. 001 ）. No differences could be found in renfection between the two groups（0 vs. 4.9%, P =0. 112）. More patients in group A underwent surgery （67.6% vs. 32. 8%, P 〈 0. 001 ）. Conclusion The new therapeutic schedule of IE could reduce the mortality rate and promote the cardiac function. The iucidemre of rc-infection didn＇t increase.

关 键 词：心内膜炎 心脏瓣膜假体植入 随访研究 危险性评估 

分 类 号：R654.2[医药卫生—外科学]