感染性心内膜炎手术危险因素分析

Risk factors associated with surgical treatment of infective endocarditis

目的回顾性分析感染性心内膜炎导致死亡与瓣周漏的危险因素,评价感染性心内膜炎手术时机选择。方法回顾性分析2015年8月至2017年8月在我院行手术治疗的62例感染性心内膜炎患者的临床资料。其中男43例、女19例,年龄19~75(46.1±16.6)岁。将临床资料分为死亡组与生存组,瓣周漏组与无瓣周漏组,急诊手术组和非急诊手术组,探讨感染性心内膜炎手术危险因素及手术时机的选择。结果 62例术后患者,早期死亡3例,死亡率4.8%,其中1例死于肾功能衰竭,1例死于多器官脏器衰竭,1例死于急性左心衰。术后瓣周漏(反流束≥2 mm)患者8例,占总体的12.9%。单因素分析显示术前患者白蛋白含量、肌酐水平、体外循环总时间和升主动脉阻断时间与术后早期死亡相关(P<0.05)。患者年龄、术前白蛋白含量、肌酐水平、体外循环总时间、升主动脉阻断时间与术后早期瓣周漏的发生相关(P<0.05)。多因素logistic回归模型分析表明,升主动脉阻断时间长是感染性心内膜炎患者术后早期死亡的独立危险因素(P<0.05),白蛋白低,年龄大是感染性心内膜炎患者术后早期瓣周漏的独立危险因素(P<0.05)。急诊手术与非急诊手术在早期死亡和瓣周漏的发生率差异无统计学意义(P>0.05)。结论感染性心内膜炎患者排除禁忌证后应早期手术治疗,手术方式的选择应根据患者实际情况分析选择,术前应注意患者白蛋白及肌酐水平,术中尽量缩短体外循环时间及升主动脉阻断时间有助于改善患者预后。

Objective To analyze the risk factors of the death associated with infective endocarditis, and to evaluate the timing of surgical treatment of infective endocarditis. Methods We retrospectively analyzed the clinical data of 62 patients with infective endocarditis in our hospital between August 2015 and August 2017. There were 43 males and 19 females at age of 19–75(46.1±16.6) years. The clinical data were divided into a death group and a survival group, a paravalvular leakage group and a no periannular leakage group, an emergency operation group and a nonemergency operation group.The risk factors of infective endocarditis and the choice of operation time were analyzed.Results Three of the 62 patients(4.8%) died after surgery. Postoperative perivalvular leakage(regurgitation over 2 mm)in 8 patients, accounting for 12.9% of the total. Univariate analysis showed that albumin content, creatinine level, total cardiopulmonary bypass time and ascending aorta occlusion time were significantly associated with early postoperative mortality(P<0.05). The results of logistic analysis showed that age, preoperative albumin level, creatinine level, total cardiopulmonary bypass time, and ascending aorta occlusion time were significantly associated with early postoperative perivascular leakage(P<0.05), and long ascending aorta occlusion time is an independent risk factor for early death(P<0.05). There was no statistical difference in early death and the perivalve leakage between the emergency operation and the non emergency operation. Conclusion Patients with infective endocarditis should accept early surgical treatment.The choice of surgical approach should be selected according to the actual situation of patients. And we should pay more attention to albumin and creatinine levels in preoperative patients. In the operation, to shorten extracorporeal circulation time and aortic clamping time can improve the prognosis of patients.