1986-2005 年，一家三级保健医院人工心脏瓣膜心内膜炎的变化面貌。

The changing face of prosthetic valve endocarditis at a tertiary-care hospital: 1986-2005.

机构信息

Servicio de Urgencias, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Cantabria, Spain.

出版信息

Rev Esp Cardiol. 2010 Jan;63(1):28-35. doi: 10.1016/s1885-5857(10)70006-2.

DOI:10.1016/s1885-5857(10)70006-2

PMID:20089223

Abstract

INTRODUCTION AND OBJECTIVES

To investigate changes in the clinical characteristics, etiology and prognosis of prosthetic valve endocarditis at a tertiary-care hospital.

METHODS

Retrospective cohort study of all patients diagnosed with prosthetic valve endocarditis using modified Duke criteria between 1986 and 2005. The analysis covered two time periods: January 1986 to December 1995 (P1) and January 1996 to December 2005 (P2).

RESULTS

In total, 133 episodes of endocarditis occurred in 122 patients. Of these, 73 (54.9%) were diagnosed in P1 and 60 (45.1%) in P2, with incidences of 2.19% and 2.18%, respectively. The patients' mean age (SD) was 52.6+/-16.6 years in P1 and 66.2+/-11.5 years in P2 (P=.0001). Clinical characteristics were similar in the two study periods. The increase in Enterococcus infection was remarkable (12.5% in P2 vs. 4.9% in P1; relative risk [RR]=2.5; 95% confidence interval [CI], 0.7-9.6), as was the decrease in viridans group Streptococcus infection (12.5% in P2 vs. 31.1% in P1; RR=0.4; 95% CI, 0.2-0.9). Some 90.4% of patients (63/73) underwent surgery in P1, while 68.3% (41/60) underwent surgery in P2. The difference was significant (RR=0.8; 95% CI, 0.6-0.9). The in-hospital mortality rate was 28.8% in P1 and 30% in P2 (RR=1; 95% CI, 0.6-1.7).

CONCLUSIONS

Changes in the epidemiology and microbiological etiology of prosthetic valve endocarditis were observed over the 20-year study period. Diagnostic and therapeutic approaches also changed, but mortality remained high.

摘要

目的

研究一家三级护理医院中人工心脏瓣膜心内膜炎的临床特征、病因和预后的变化。

方法

回顾性分析 1986 年至 2005 年间使用改良的 Duke 标准诊断为人工心脏瓣膜心内膜炎的所有患者的队列研究。分析涵盖两个时间段：1986 年 1 月至 1995 年 12 月（P1）和 1996 年 1 月至 2005 年 12 月（P2）。

结果

共发生 133 例心内膜炎，122 例患者中 73 例（54.9%）为 P1 期，60 例（45.1%）为 P2 期，发病率分别为 2.19%和 2.18%。患者的平均年龄（SD）分别为 P1 期 52.6±16.6 岁和 P2 期 66.2±11.5 岁（P=0.0001）。两个研究期的临床特征相似。肠球菌感染显著增加（P2 期 12.5%，P1 期 4.9%；相对风险 [RR]=2.5；95%置信区间 [CI]，0.7-9.6），而草绿色链球菌感染减少（P2 期 12.5%，P1 期 31.1%；RR=0.4；95%CI，0.2-0.9）。P1 期 90.4%（63/73）的患者接受手术治疗，P2 期 68.3%（41/60）的患者接受手术治疗，差异有统计学意义（RR=0.8；95%CI，0.6-0.9）。P1 期住院死亡率为 28.8%，P2 期为 30%（RR=1；95%CI，0.6-1.7）。