| Objective:This thesis aims to analyze the clinical data of 86 patients with infective endocarditis who underwent surgical treatment from January 2009 to December2018 in the Department of Cardiothoracic Surgery,Central Hospital of Enshi Tujia and Miao Autonomous Perfectuer,Hubei Province.To explore the clinical characteristics,pathogenic microbial characteristics,surgical treatment,and prognosis of patients with infective endocarditis in order to improve the clinical diagnosis and treatment of infective endocarditis.Methods : Based on the complete clinical data of 86 patients with infective endocarditis who underwent surgical treatment from January 2009 to December2018 in the Department of Cardiothoracic Surgery,Central Hospital of Enshi Tujia and Miao Autonomous Perfectuer,Hubei Province.Including patient’s gender,age,clinical manifestations,pathogen Microbiological results,echocardiography and chest X-ray characteristics,ECG performance,presence or absence of underlying heart disease,laboratory tests(white blood cell count,neutrophil percentage,hemoglobin,C-reactive protein,red blood cell sedimentation rate,calcitonin Prototype,alanine aminotransferase,aspartate aminotransferase),urine routine(hematuria,proteinuria),preoperative cardiac function classification,preoperative treatment,surgical timing,surgical methods,prognosis and follow-up data,ect.the author carried out his research on this topic.All patients underwent surgical treatment under general anesthesia and hypothermia.The follow-up period was from 1 to 60 months.The follow-up content mainly included the postoperative cardiac function classification,left ventricular ejection fraction,left ventricular end-diastolic diameter,left ventricular short axis shortening rate,Whether there is perivalvular leakage and so on.Results:1.In this study,53 of the 86 patients were hospitalized in Cardiothoracic Surgery for the first time,and 33 cases were transferred from other departments of our hospital.The age of the patients was 10 to 81 years,and the average age was47.82±16.70 years.There were 52 male patients and 34 female patients.The ratio of male to female was about 1.53: 1.There were 25 cases of acute infective endocarditis(29.07%),57 cases of subacute infective endocarditis(66.28%),and 4cases of chronic infective endocarditis(4.65%).The number of hospital stays 15 to68 days,with an average of 36.88 ± 11.51 days.2.The main clinical manifestations of patients in this group were 79 cases of fever(91.86%)and 75 cases of heart murmur or newly generated murmur(87.21%).3.Auxiliary examinations:All patients underwent echocardiography before operation,and 75 patients(87.21%)had neoplasms with different shapes and sizes.All patients’ heart valves were affected to varying degrees.32 patients(37.21%)were affected by aortic valve alone,25(29.07%)were affected by mitral valve alone,and14(16.28%)were affected by aortic valve + mitral valve.6 cases(6.98%)were affected by mitral valve + tricuspid valve,4 cases(4.65%)were affected by aortic valve + mitral valve + tricuspid valve,3 cases(3.49%)were affected by aortic valve+ tricuspid valve,2 cases of pulmonary valve(2.33%).There were 16 cases of rheumatic heart valve disease(18.60%);5 cases of congenital heart disease(5.81%):2 cases of open ductus arteriosus,1 case of tetralogy of Fallot,1 ventricular septal defect + right ventricular double-chamber heart 1 Cases,1 case with ventricular septal defect;2 cases with previous history of cardiac surgery(2.33%): 1 case after repair of ventricular septal defect,1 case after mitral valve replacement;12 cases with aortic valve valvular deformity(13.95%).Preoperative secondary lesions: 5cases of mitral valve perforation(5.81%),4 cases of perivalvular abscess(4.65%),3cases of mitral valve chordae rupture(3.49%),3 cases of mitral valve prolapse(3.49%);There were 2 cases of aortic valve perforation(2.33%),2 cases of aortic valve prolapse(2.33%),and 1 case of anterior mitral valve rupture(1.16%).Other auxiliary examination results include the size of each heart cavity,ECG changes,chest X-rays,and laboratory tests.4.In this study,27 patients(31.40%)were positive for Preoperative blood cultures,the main pathogenic microorganisms causing infective endocarditis were streptococci wih 18 cases(20.93%),and 9 cases of Streptococcus viridans 10.47%),Followed by 5 cases(5.81%)of Staphylococcus aureus,3 cases(3.49%)of bacilli,and 1 case(1.16%)of fungus(yeast-like).5.Preoperative echocardiographic prompts: left ventricular end-diastolic inner diameter 39 to 66 mm,with an average of 51.10 ± 6.07 mm;the left ventricular short-axis shortening rate was 17 to 39 %,and the average value was 31.26 ± 3.50%;Left ventricular ejection fraction 35 to 75 %,with an average of 60(55-65)%.Postoperative review echocardiography showed that the left ventricular end-diastolic diameter was 40 to 59 mm,with an average of 48.73 ± 5.53 mm;the short-axis shortening rate of the left ventricle was 27 to 40 %,with an average of 32.60 ± 3.80%;Left The ventricular ejection fraction was 40 to 70 %,with an average of 59.66 ±6.29 %.The difference between the corresponding values of echocardiogras before and half a year after surgery was statistically significant,with P values of 0.002,0.015,and 0.019,respectively,both of which were less than 0.05.6.All 86 patients underwent surgical treatment in the study.81 patients(94.17%)recovered and were discharged from the hospita after surgery,and 5patients died early after surgery(5.81%).Risk factors affecting early postoperative death in patients with infective endocarditis by univariate analysis included age(P =0.005),inner diameter of left ventricular end diastole(P = 0.036),left ventricular ejection fraction(P <0.001),Cardiopulmonary bypass time(P = 0.001),ascending aortic block time(P <0.001).Multivariate logistic regression analysis suggested that left ventricular ejection fraction(P = 0.034)and ascending aortic occlusion time(P =0.035)were high-risk factors affecting early postoperative death in patients with infective endocarditis.7.Postoperative follow-up: 2 patients lost contact,the follow-up rate was91.86% and the follow-up period was 1 to 60 months,with an average of 22.08 ±13.09 months.No recurrence of infective endocarditis and pervalvular leakage were found after the operation,and To some extent,heart function has been significantly improved.The cardiac function classification standard adopted the New York Heart Associationg(NYHA)cardiac function classification method.The preoperative cardiac function was classified into 6 cases of gradeⅠ(6.98%),19 cases of grade Ⅱ(22.09%),31 cases of grade Ⅲ(36.05%),and 30 cases of grade Ⅳ(34.88%).In the postoperative half year,the cardiac function was classified into 37 cases of graded Ⅰ(46.84%)and 42 cases of graded Ⅱ(53.16%).There was significant difference between preoperative and postoperative heart function grading,P = 0.000 < 0.01.Conclusion: 1.Infective endocarditis is predominantly male and middle-aged and elderly patients,and is mainly subacute;clinical manifestations are more common with fever and cardiac murmur.2.The diagnosis of infective endocarditis is mainly based on blood culture and echocardiographic examination results.Heart valve involvement is more common in aortic valve,and the main pathogenic microorganisms are streptococci.3.Comprehensive evaluation of the patient’s condition,flexible grasp of the clinical guidelines for surgical treatment of infective endocarditis,grasping the surgical indications and timing,and selecting the correct surgical method are essential for surgical treatment of infective endocarditis.Surgical treatment of infective endocarditis has a good effect.4.The lower the left ventricular ejection fraction before surgery and the longer the ascending aortic occlusion time are the high-risk factors affecting postoperative death in patients with infective endocardium.5.The clinical features of infective endocarditis are complex,strengthen the understanding of epidemiology,susceptibility factors and clinical manifestations of infective endocarditis,prevent misdiagnosis and missed diagnosis,and improve the diagnosis and treatment of infective endocarditis. |
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