感染性心内膜炎的外科治疗

The Surgical Treatment of Infective Endocarditis

目的探讨IE外科治疗的效果及其影响因素,从而加深对IE的认识,以期提高IE治愈率。方法根据术前是否发热,将手术分为感染稳定期手术和感染急性期手术两组,比较不同手术时机对手术近期效果的影响;根据术后近期结局,将手术分为生存组和死亡组,探讨术前危险因素对手术预后的影响。结果外科治疗病死率显著低于内科治疗病死率,P<0.001。内科治疗平均住院时间明显长于外科治疗平均住院时间,P<0.05。感染稳定期手术的术后病死率和并发症明显低于感染急性期手术,P<0.05;而感染急性期手术的术后呼吸机辅助呼吸时间和ICU监护时间显著长于感染稳定期手术,P<0.001。死亡组急性期手术和赘生物直径≥10mm的比例明显高于生存组,P<0.05;死亡组术前体温≥38℃和术前Ⅳ级心功比例显著高于生存组,P<0.001。通过logistic多元回归分析,发现术前心力衰竭和急性期手术是影响手术预后的最强因素。结论外科手术能提高IE的治愈率,外科治疗的关键在于手术时机的把握,非急诊手术应尽量于感染稳定期手术,以减少术后病死率和术后并发症。

Objective To reveal the different operative effect between the acute stage operation and the stable phase operation, as well as the prognostic influence resulting from different preoperative risk factor by retrospective study, so as to deepen recognition about IE to boost its＇ cure rate. Methods According to preoperative temperature is or not febrile, the operative patients were divided into acute stage operation group and stable phase operation group, the different outcome was analyzed. ASeeording to the operative cortsequence, the operative patients was divided into dead group and survival group, their prognostic influence resulting from preoperative risk factor was analyzed, and the dangerous factors were studied through logistic regression. Data analysis was perforated by using SPSS for windows. Results The mortality of medical treated group was higher than surgical therapeutic group obviously, P 〈 0.001.The average stay of medical treated group was longer than control groups, P 〈 0.05. The time of ICU monitoring, and the time of breathing machine assisted after opelation in acute stage operation group was longer than the control group＇s, P 〈 0.001 ; the mortality, and the rate of complications in acute stage operation group was higher than the control group＇s, P 〈 0.001 .The proportion of Ⅳ grades cardiac hmction and acute stage operation in the death group was higher than the survival group＇s, P 〈 0.05.The heart failure was the most dangerous prognostic factor. Conclusion The cure rate of IE can be elevated by medical treatment combined operation. To reduce the mortality and postoperative complication,it＇s advisable to operate during stable time.