感染性心内膜炎患者手术死亡相关风险因素研究

Studies on risk factors associated with death from infective endocarditis surgery

目的探讨感染性心内膜炎(infecfine endocarditis,IE)手术死亡风险因素。方法选取2008年1月至2018年1月云南省第一人民医院收治的IE患者80例,根据手术结果分为手术成功组(n=60)和术后死亡组(n=20)o采用回顾性研究方法,收集两组患者的一般资料(包括性别、年龄,有无外周血管疾病,是否吸烟,是否行胸部手术,有无腹痛、胸痛、恶心及低血压)、实验室检查结果及术中停止循环时间。结果最终入选80例IE患者,其中手术成功组60例(75%),术后死亡组20例(25%)。两组年龄[手术成功组(46.2±0.3)岁,术后死亡组(51.3±1.9)岁,P=0.013]、胸痛发生率(手术成功组18.3%,术后死亡组90.0%,P=0.000)、腹痛发生率(手术成功组8.3%,术后死亡组55.0%,P=0.000)、低血压发生率(手术成功组3.3%,术后死亡组75.0%,P=0.000)及血小板计数(PLT)发生率(手术成功组76.7%于60×10^9/L﹤PLT≤150×10^9/L,术后死亡组75.0%于43×10^9/L≤PLT≤59×10^7L,P=0.000)、术中停止循环时间(手术成功组85%60 min矣停止循环时间名120 min,术后死亡组85%120 min<停止循环时间专250 min,P=0.000)比较差异有统计学意义(P<0.05);而性别、吸烟率及外周血管疾病、恶心/呕吐发生率两组比较差异无统计学意义(P>0.05)。单因素Logistic回归分析结果表明,年龄(B=-0.0441,P=0.0021)、胸痛(B=-0.0321,P=0.0000)、腹痛(B=-0.0125,P=0.0311)、低血压(B=-0.2818,P=0.0312)、PLT(B=-0.1631,P=0.0025)、停止循环时间(B=-0.2513,P=0.0000)与死亡有独立的关联。结论感染性心内膜炎患者的年龄>60岁,术前出现胸痛、腹痛和低血压,术前PLT越低,术中停止循环时间延长,均能增加手术死亡风险。

Objective To explore the death-related risk factors associated with infective endocarditis surgery.Methods A total of 80 infective endocarditis patients admitted to the First People's Hospital of Yunnan Province from January 2008 to January 2018 were selected,and according to surgical results were divided into successful group(n=60)and postoperative death group(n=20).The retrospective study method was adopted.Basic information of the two groups of patients were collected included gender,age,presence of peripheral vascular disease,smoking,requirement for chest surgery,and presence of abdominal pain,chest pain,nausea,hypotension.Laboratory test results and also collected.Results Finally,80 patients with infective endocarditis were enrolled,including 60 patients(75%)in the successful group and 20 patients(25%)in the postoperative death group.The age of the two groups(46.2±0.3 in the successful group,51.3±1.9 in the postoperative death group,P=0.013),chest pain(18.3%in the successful group,90%in the postoperative death group,P=0.000),abdominal pain(8.3%in the successful group,55%in postoperative death group,P=0.000),hypotension(3.3%in the successful group,75%in postoperative death group,P=0.000)and platelet value(located at 60×10^9/L﹤PLT≤150×10^9/L,75%of the'postoperative death group is located at 43×10^9/L≤PLT≤59×10^9/L,P=0.000),and the intraoperative circulatoiy time(85%of the successful group is located 60 min≤the time to stop C 120 min,85%of the postoperative death group was located at 120 min<the time to stop250 min,P=0.000),and there was no significant difference in gender,smoking rate,peripheral vascular disease,and incidence of nausea/vomiting(P>0.05).Univariate Logistic regression analysis showed age(B=-0.0441,P=0.0021),.chest pain(B=-0.0321,P=0.0000),abdominal pain(B=-0.0125,P=0.0311),and hypotension(B=-0.2818,P=0.0312),platelet values(B=-0.1631,P=0.0025),and the time to stop(B=-0.2513,P=.0.0000)were independently associated with death.Conclusion Infective endocarditis the patient is older than 60 years old,preoperative chest pain,abdominal pain and hypotension,low preoperative platelet count,and may increase the risk of surgical death.