| 【Objective】The infective endocarditis has a low incidence rate,but teh mortality rate is high.The prognosis of the disease is closely related to the epidemiology,So in the first part we reviewed and summarized the epidemiological characteristics of infective endocarditis.Although surgical treatment reduced the mortality rate of infective endocarditis,there are still many controversies about the risk of surgery treatment.In the second part,we research the risk factors that affecting patient,s early postoperative death.【Methods】(一)Analysis of epidemiological characteristics of infective endocarditis1.Select 307 patients who experienced Infective Endocarditis.Describe the demographic characteristics,major symptoms,complications,echocardiographic characteristics,and distribution of pathogenic microorganisms.2.Select 15 patients who experienced prosthetic valve endocarditis(PVE),Describe demographic characteristics,main symptoms,complications,distribution of disease course,features of echocardiography,and distribution of pathogenic microorganisms.3.Select 17 patients who experienced right heart valve endocarditis,Describe demographic characteristics,major symptoms,complications,distribution of disease course,features of echocardiography,and distribution of pathogenic microorganisms4.307 patients were divided into three groups : acute group,subacute group and chronic group.Compare the epidemiological characteristics among the three groups.(二)Analysis of risk factors for in-hospital death1.Select 307 patients who experienced Infective Endocarditis that all patients undergo surgical treatment.2.Analysis age,gender,duration,PVE,IE-related stroke,IE-related embolism,atrial fibrillation,atrioventricular block,diabetes,hypertension,preoperative,cardiogenic and infectious shock,preoperative mechanical Assisted ventilation,NYHAIV grade,LVEF,LVEDV,neoplasm-affected valves,pathogenic microorganism species,white blood cell count,platelet count,creatinine clearance,total bilirubin,albumin,cardiopulmonary bypass time,postoperative mechanical assisted ventilation time3.Statistical comparisons were made using the unpaired t-test(para-metric data)or Mann-Whitney’s U-test(non-parametric data).Categorical variables were analyzed using the chi-square test.To identify prognostic predictors,a multivariate logistic regression analysis was used.The independent variables entered into this analysis were chosen by statistical tests that showed the differences between the two groups(p<0.05).To evaluate the predictive ability for mortality,a receiver operating characteristic(ROC)analysis was performed.All analyses were performed using the SPSS software package and a p value of <0.05 was considered to be statistically significant.【Results】(一)The Infective Endocarditis Epidemiological Analysis1.The median age of the patients was 42(31-53),228(74.3%)were men.275 patients(89.6%)complained of persistent or repeated fever(temperature >38°C).192 patients(62.5%)had heart failure.65 patients(23.2%)had a history of embolism.34(11.1%)patients had a history of stroke.Preoperative anemia in 150 patients(48.9%).35 patients(11.4%)had preoperative hypoproteinemia.Blood cultures were positive in 128 patients(41.3%),including 65(50.8%)oral streptococcal infections and 37(28.9%)staphylococcal infections.149 patients(48.5%)had vegetation involving the mitral valve,211 patients(68.7%)had vegetation involving the aortic valve,11 patients(3.6%)had vegetation involving the tricuspid valve,and 10 patients(3.3%)had involvement of the pulmonary valve.17 patients had ventricular septal defect(5.5%)and 8 patients(2.6%)had patent ductus arteriosus.2.15 cases(4.9%)were prosthetic valve endocarditis,the median age was 41 years(33-53).11 cases(73.3%)were acute Infective Endocarditis.Ten cases(66.7%)involved the aortic valve.5 patients(33.3%)had mitral valve involvement.NYHA classification III-IV 12 cases(80%).Blood cultures were positive in 8 cases(53.3%)which Staphylococcus in 5 cases(62.5%).4 cases(26.7%)were dead after surgery treatment.3.There were 17 patients(5.5%)with right heart valve endocarditis and the median age was 38 years(26-51).There were 11 cases(64.7%)involving the tricuspid valve and 10 cases(58.8%)involving the pulmonary valve.There were 11(64.7%)NYHA III-IV.Blood cultures were positive in 5 cases(29.4%).9 patients(52.9%)had ventricular septal defect and 3(17.6%)had sinus tumors.Negative blood culture in 11 cases(64.7%).2 cases(11.8%)were dead after surgery treatment.4.Comparison between acute IE and subacute IE:Prosthetic valve endocarditis and severe mitral regurgitation had significant difference.Comparison between acute IE and chronic IE:Heart failure,NYHAIV class,LVEF,LVEDV,severe mitral regurgitation,Staphylococcus aureus,Staphylococcus had significant difference.Comparison of subacute IE with chronic IE: LVEF had significant difference.(二)Analysis of risk factors for in-hospital death288 patients in the cured group,19 patients in the death group,mortality rate was 6.2%.Perform statistical descriptions,normality tests,single-factor analysis,logistic regression,ROC curves,and Yoden index operations.Independent risk factors include NYHAIV class,white blood cell count,cardiopulmonary bypass time,postoperative mechanically assisted ventilation time.NYHAIV prediction accuracy rate was 75.2%.White blood cell accuracy rate was 75.4%,Cutting point is 9.5*10^9/L,accuracy rate was 68.4%,specificity rate was 73.6%,The prediction accuracy rate of cardiopulmonary bypass time was 75.3%,Cutting point is 199 min,accuracy rate was 42.1%,specificity rate was is 95.8%.The prediction accuracy rate of mechanical ventilation was 77.8%,the cut point was 67 hours,the accuracy rate was 68.4%,and the specificity rate was 92.7%.【Conclusions】(一)The Infective Endocarditis Epidemiological Analysis1.The age of the patient is mainly young and middle-aged2.Fever and heart failure are the main manifestations of infective endocarditis and the incidence of embolism is about 21%.3.Steroids most often affect the aortic valve,then the mitral valve,often causing valve insufficiency.4.Mitral stenosis has a low incidence rate5.Ventricular septal defect is more common in patients with infective endocarditis,mainly seen in patients with right heart valve endocarditis.6.Staphylococcus is the most common pathogenic microorganism.The mortality rate of patients with vegetation-affected artificial aortic valves is higher.7.The patients who experienced chronic infective endocarditis had worse heart function.8.The patients who experienced acute infective endocarditis had Higher rates of staph infection but the heart function is better.(二)Analysis of risk factors for in-hospital deathWhite blood cell count,grade IV cardiac function,cardiopulmonary bypass time,postoperative mechanically assisted ventilation time are independent risk factors.Reasonable antibiotics and heart function improvement should be programmed before suegery.Myocardial protection,avoide excessive time of extracorporeal circulation,prevention of excessive systemic inflammatory response to cardiopulmonary bypass should be caution In surgery.use anti-inflammatory drugs to reduce systemic inflammatory response to cardiopulmonary bypass aftre surgery... |
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