人工瓣膜心内膜炎：管理策略和预后：突尼斯一家三级护理中心的十年分析。

Prosthetic valve endocarditis: management strategies and prognosis: A ten-year analysis in a tertiary care centre in Tunisia.

机构信息

Department of Cardiology, University Hospital Hedi Chaker, Sfax, Tunisia.

出版信息

Neth Heart J. 2009 Feb;17(2):56-60. doi: 10.1007/BF03086218.

DOI:10.1007/BF03086218

PMID:19247467

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC2644380/

Abstract

BACKGROUND

Prosthetic valve endocarditis (PVE) is a rare and serious complication after heart valve replacement; its optimal management strategy, though, still needs to be defined.

OBJECTIVE

To study the clinical, microbiological and echocardiographic characteristics of PVE and to analyse the influence of the adopted therapeutic strategy (medical or surgical) on short- and midterm outcome in a tertiary care centre in a developing country (Tunisia).

METHODS

All cases of PVE treated in our institution between 1997 and 2006 were retrospectively analysed according to the modified DUKE criteria.

RESULTS

A total of 48 PVE episodes were diagnosed (30 men and 18 women), mean age was 37.93 years. Twenty-eight patients (58.33%) were exclusively medically treated, whereas 20 (41.66%) were treated by a combined surgical and medical strategy. Indications for surgery were haemodynamic deterioration in eight patients (40%), annular abscess in six (30%) and persisting sepsis in six (30%). In comparison with those from the medical group, operated patients had a longer delay to diagnosis (p=0.025), were more frequently in heart failure (p=0.04) and experienced more early complications (p=0.011); they also more frequently had prosthetic dehiscence (p=0.015), annular abscesses (p=0.039) and vegetations >10 mm (p=0.008). Conversely, no differences were found between the groups in terms of age, sex, or nature of involved organisms. In-hospital mortality for the medical group was 14.28% and for the surgical group 35% (p=0.09).

CONCLUSION

PVE is a very serious condition carrying high mortality rates regardless of the adopted strategy. Our study demonstrates that, in selected patients, medical treatment could be a successful and acceptable approach. (Neth Heart J 2009;17: 56-60.).

摘要

背景

人工心脏瓣膜心内膜炎（PVE）是心脏瓣膜置换术后一种罕见且严重的并发症；然而，其最佳治疗策略仍需要确定。

目的

研究 PVE 的临床、微生物学和超声心动图特征，并分析在发展中国家（突尼斯）的三级医疗中心采用的治疗策略（药物或手术）对短期和中期结果的影响。

方法

根据改良的 DUKE 标准，回顾性分析了 1997 年至 2006 年间在我院治疗的所有 PVE 病例。

结果

共诊断出 48 例 PVE 发作（30 名男性和 18 名女性），平均年龄为 37.93 岁。28 例（58.33%）仅接受药物治疗，20 例（41.66%）接受联合手术和药物治疗策略。手术指征为 8 例（40%）患者出现血流动力学恶化，6 例（30%）患者出现环形脓肿，6 例（30%）患者出现持续性败血症。与药物组相比，手术组的诊断延迟时间更长（p=0.025），心力衰竭发生率更高（p=0.04），早期并发症更多（p=0.011）；他们也更频繁地出现人工瓣膜裂开（p=0.015）、环形脓肿（p=0.039）和大于 10mm 的赘生物（p=0.008）。然而，两组在年龄、性别或受累生物体的性质方面没有差异。药物组的院内死亡率为 14.28%，手术组为 35%（p=0.09）。