目的:分析感染性心内膜炎(infective endocarditis ,IE)的临床特征及影响IE术后短期预后的因素,探讨IE患者接受手术治疗的合适时机. 方法:收集安徽医科大学第一附属医院2003年6月至2017年10月接受手术治疗的202例IE患者的临床资料,回顾性分析IE患者的临床特点及手术时机的选择. 结果:202例患者经手术治愈191例(治愈组) ,死亡11例(死亡组) .患者平均年龄为(40 .0 ± 14 .6 )岁,主要发病原因以非风湿性瓣膜病变(49 .0%)最常见,其次为先天性心脏病(28 .7%) 、风湿性心脏病(16 .8%) 、瓣膜置换术后(4 .5%)等,主动脉瓣为最常受累的心脏结构(38 .1%) ,其次为二尖瓣(28 .7%) ;相对于治愈组,死亡组患者年龄较大,多为主动脉瓣和二尖瓣同时受累,具有瓣膜置换病史(P均＜0 .05).患者主要临床表现为发热(87 .1%)、心脏杂音(37 .1%) 、气促(58 .4%) 、胸痛胸闷(40 .6%) ,常见并发症有心功能不全(55 .9%) 、栓塞(13 .4%) 、慢性肾脏病(8 .9%) 、脑出血(6 .9%)等;死亡组急性心力衰竭、急性肾损伤、慢性肾脏病、多器官功能障碍综合征等相关并发症明显多于治愈组( P均＜0 .001 ) . IE致病菌主要为链球菌(55 .1%)及葡萄球菌(26 .1%) ,微生物培养阴性患者死亡率较高( P＜0 .05 ) ;术前接受规范抗感染治疗的181例患者术后死亡10例(5 .5%) ,未完成规范抗感染治疗的21例患者术后死亡1例(4 .8%) ,两组差异无统计学意义. 结论:对于年龄较大、多瓣膜同时受累、有瓣膜置换病史、合并心肾功能损伤及微生物培养阴性的IE患者应进行完善的术前评估及术前准备,而是否完成规范抗感染治疗不影响术后死亡率;对于存在急性心力衰竭、感染性休克、瓣膜穿孔、赘生物脱落风险或栓塞并发症的IE患者应尽早行手术治疗.%Objective :To study the clinical manifestations and the short-term prognostic factors after surgery of infective endocarditis (IE) ,and to explore the appropriate time to surgery . Methods :A total of 202 IE patients who underwent surgery in the First Affiliated Hospital of Anhui Medical University from June 2003 to October 2017 were enrolled and the clinical datas were retrospectively analyzed . Results :In the 202 patients ,191 were cured and 11 died .The average age of disease onset was 40 .0 ± 14 .6 years among these cases .The most common causes of IE were non-rheumatic valve disease (49 .0%) ,followed by congenital heart disease (28 .7%) ,rheumatic heart disease (16 .8%) and valve replacement (4 .5%).The most frequently involved cardiac structure was aortic valve (38 .1%) , followed by mitral valve (28 .7%).The patients were older ,mostly with both aortic and mitral valve involvement and a history of valve replacement in the death group ,compared with cured group (P＜0 .05).The main clinical manifestations were fever (87 .1%) ,cardiac murmur (37 .1%) ,shortness of breath (58 .4%) and chest pain (40 .6%).The common complications were cardiac insufficiency (55 .9%) ,embolism (13 .4%) ,chronic kidney disease (8 .9%) and cerebral hemorrhage (6 .9%).The incidence of acute heart failure , acute kidney injury , chronic kidney disease and multiple organ dysfunction syndrome in the death group were significantly higher than those in the cured group (all P＜0 .001).The main causative bacteria were Streptococcus (55 .1%) and Staphylococcus (26 .1%).The mortality of patients with negative microbial culture was higher (P＜0 .05).A total of 181 cases received standard anti-infective treatmentbefore operation ,10 of which died (5 .5%) ,while 21 cases did not complete standard anti-infection treatment before operation ,only 1 of which died (4 .8%).There was no statistically difference between the two groups (P＝1 .000). Conclusions :Preoperative evaluation and preparation should be performed in older IE patients with multiple valves involvement ,a history of valves replacement , cardiac and renal impairment and negative microbial culture . Whether standard anti-infection therapy could be complete did not affect postoperative mortality .Surgical treatment should be early performed in IE patients with with acute heart failure ,septic shock ,valves perforation and vegetation loss or embolism .
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