手术治疗在人造瓣膜感染性心内膜炎中的应用及效果:一项国际多中心队列研究的倾向分析
The use and effect of surgical therapy for prosthetic valve infective endocarditis: A propensity analysis of a multicenter, international cohort出 版 物：《世界核心医学期刊文摘(心脏病学分册)》 (Digest of the World Core Medical Journals(Cardiology))
年 卷 期：2006年第4期
页 面：40-41页
学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学]
摘 要：Background: Although surgical intervention is often used in the treatment of prosthetic valve infective endocarditis(PVIE), an understanding of its effect on survival has been limited by the biases of observational studies and lack of con trolled trials. Methods: The International Collaboration on Endocarditis Merged Database is a large, multicenter, international registry of patients with definite endocardi tis by Duke criteria, including 367 patients with PVIE. Clinical, microbiologic, and echocardiographic variables were analyzed to determine those factors associ ated with the use of surgery for PVIE. Logistic regression analysis was performe d to create a propensity model of predictors of surgery use. Patients who underw ent surgery during initial hospitalization were matched by propensity score with patients treated with medical therapy alone. Logistic regression analysis was p erformed to determine variables independently associated with inhospital mortali ty in this matched subset. Results: Surgical therapy for PVIE was performed in 1 48(42%)of 367 patients. Inhospital mortality was similar for patients treated w ith surgery compared with those treated with medical therapy alone(25.0%vs 23.4 %, P=.729). Surgical therapy was independently associated with patient age, mic roorganism, intracardiac abscess, and congestive heart failure. After adjustment for these determinants, inhospital mortality was predicted by brain embolizatio n(OR 11.12, 95%CI 4.16-29.73)and Staphylococcus aureus infection(OR 3.67, 95% CI 1.29-9.74), with a trend toward benefit for surgery(OR 0.56, 95%CI 0.23-1. 36). Conclusions: Despite the frequent use of surgery for the treatment of PVIE, this condition continues to be associated with a high inhospital mortality rate in the contemporary era. After adjustment for factors related to surgical inter vention, brain embolism and S aureus infection were independently associated wit h inhospital mortality and a trend toward a survival benefit of
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