主动脉瓣感染性心内膜炎瓣膜置换术后远期效果
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首都医科大学附属北京安贞医院感染科, 北京 100029

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朱光发  E-mail: gfzhu6388@sina.com

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Long-term effect of aortic valve infective endocarditis after surgical aortic valve replacement
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Department of Infectious Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China

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    摘要:

    目的 探讨自体主动脉瓣单独受累感染性心内膜炎(IE)对外科主动脉瓣置换术(SAVR)远期预后的影响。 方法 回顾性分析2013年1月—2017年12月在首都医科大学附属北京安贞医院行SAVR的自体主动脉瓣单独受累IE患者的病历资料,同时采用倾向性评分匹配(PSM)非IE对照组患者,对所有入组患者进行长期随访,观察术后生存率及并发症累积发生风险,中位随访时间为69个月。 结果 共纳入2 821例患者,其中IE SAVR患者143例(IE组),非IE的SAVR患者2 678例(对照组)。IE组患者长期生存率低于非IE配对对照组,差异有统计学意义(P=0.044)。IE患者SAVR手术后更容易发生缺血性脑卒中事件,差异有统计学意义(P=0.035),且缺血性脑卒中事件为影响患者生存的独立危险因素(P=0.014),发生缺血性脑卒中患者的死亡风险更高(HR=2.811;95%CI:1.233~6.408)。IE组患者大出血累积发生率和主动脉瓣再手术率与非IE配对对照组比较,差异均无统计学意义(均P>0.05),且均不是影响患者生存的独立危险因素(均P>0.05)。 结论 与非IE对照组患者相比,自体主动脉瓣单独受累IE患者行SAVR后发生死亡、缺血性卒中的风险更高。应加强对IE患者行SAVR后的密切随访,重点预防脑卒中等并发症。

    Abstract:

    Objective To investigate the effect of native-valve infective endocarditis (IE) on long-term effect of surgical aortic valve replacement (SAVR). Methods Medical records of patients with native-valve IE who underwent SAVR in Beijing Anzhen Hospital, Capital Medical University from January 2013 to December 2017 were analyzed retrospectively, propensity score matching (PSM) was adopted to select patients as control group (non-IE), all patients were followed up for a long period to observe the post-operative survival rate and cumulative risk of complications, the median follow-up time was 69 months. Results A total of 2 821 patients were included in study, including 143 SAVR patients with IE (IE group) and 2 678 SAVR patients without IE (control group). The long-term survival rate of patients in IE group was lower than that of control group, difference was significant (P=0.044). Patients with IE were more likely to have ischemic stroke after SAVR, difference was significant (P=0.035), ischemic stroke was an independent risk factor affecting the survival of patients (P=0.014), patients with ischemic stroke had a higher risk of death (HR=2.811; 95% CI: 1.233-6.408). There was no significant diffe-rence in the cumulative incidence of massive hemorrhage and aortic valve re-operation rate between patients in IE group and control group (both P>0.05), and they were not independent risk factors affecting the survival of patients (all P>0.05). Conclusion Compared with patients in control group, patients with native-valve IE have a higher risk of death and ischemic stroke after SAVR. The close follow-up of IE patients after SAVR should be strengthened, focusing on the prevention of complications of stroke.

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引用本文

贾一琼,朱光发.主动脉瓣感染性心内膜炎瓣膜置换术后远期效果[J]. 中国感染控制杂志,2021,(11):1022-1027. DOI:10.12138/j. issn.1671-9638.20211465.
Yi-qiong JIA, Guang-fa ZHU. Long-term effect of aortic valve infective endocarditis after surgical aortic valve replacement[J]. Chin J Infect Control, 2021,(11):1022-1027. DOI:10.12138/j. issn.1671-9638.20211465.

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  • 收稿日期:2021-05-21
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  • 在线发布日期: 2024-04-26
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