感染性心内膜炎患者二尖瓣置换和成型术的效果

Comparison between patients with infective endocarditis undergoing mitral valve replacement and valvuloplasty

中文关键词: 感染性心内膜炎  瓣膜置换  瓣膜成型

英文关键词: Infective endocarditis  Valve replacement  Valvuloplasty

中文摘要:

      
目的 比较感染性心内膜炎患者行二尖瓣置换和成型手术的临床特点和转归。
方法 回顾性分析2013年1月至2016年12月在北京协和医院行手术治疗的、累及二尖瓣的感染性心内膜炎患者55例,男24例,女31例,年龄19～77岁,ASA Ⅱ—Ⅳ级,根据患者所行手术分为两组: 二尖瓣置换术组(Z组,n=15)和二尖瓣成型术组(C组,n=40)。比较两组致病菌、临床表现、超声心动图表现、术后是否入ICU、术后住院时间、术后并发症等。
结果 链球菌是感染性心内膜炎最常见的病原菌,发热、新出现的心脏杂音和贫血是最常见的临床表现。Z组贫血、心力衰竭、术后入ICU比例明显高于C组(P<0.05)。两组超声心动图表现、术后住院时间和术后并发症差异无统计学意义。
结论 对于有手术指征的感染性心内膜炎患者,合理选择手术方式可以改善患者预后。

英文摘要:

      
Objective To summarize clinical characteristics and outcome of mitral valve infective endocarditis.
Methods Fifty-five patients diagnosed with mitral valve infective endocarditis, 24 males and 31 females, aged 19 - 77 years, falling into ASA physical status Ⅱ - Ⅳ, from January 2013 to December 2016 were enrolled. Medical records were retrospectively reviewed. All patients were divided into two groups: mitral valve replacement group (group Z, n = 15) and mitral valvuloplasty group (group C, n = 40). The pathogenic bacteria clinical manifestation, echocardiography examination,complications, admission to ICU and the length of stay were recorded.
Results Fever,new-onset cardiac murmur and anemia were the most common clinical features. The most common causative pathogen was Streptococcus. Compared to patients in group C, the incidences of anemia, heart failure, pneumonia and respiratory failure were higher in patients of group Z. More patients required postoperative intensive care unit (ICU) stay in group Z. There was no in-hospital mortality in both groups. And there was no difference in the postoperative length of stay and complications between the two groups.
Conclusion The management of infective endocarditis requires multidispilinary collaboration. Rational surgical intervention can improve patients’ outcome.