弁腔外科手術と,心不全によって合併された感染症性心内炎の患者の死亡率との関連
Todd Kiefer1, Lawrence Park, Christophe Tribouilloy
1Duke University Medical Center, Durham, NC 27710, USA.
JAMA
|November 24, 2011
まとめ
心不全 (HF) は,感染性心内炎の一般的な合併症です. 感染性内心炎およびHFの患者における弁腔外科手術は,入院および1年後の死亡率を大幅に減少させます.
科学分野:
- 心臓病学 心臓病学
- 感染症 感染症は感染症です.
- 心臓外科手術について
背景:
- 心不全 (HF) は,感染性内心炎 (IE) の最も頻繁な合併症です.
- 臨床的特徴,外科的治療,およびIE患者におけるHFのアウトカムについては,十分に定義されていません.
- これらの要因を理解することは,患者の管理を改善するために非常に重要です.
研究 の 目的:
- IE患者におけるHFに関連した臨床的,エコーカルディオグラフィック,および微生物学的要因を特定する.
- HFのIE患者における入院および1年間の死亡率に関連する変数を評価する.
- 外科療法による治療結果の影響を評価する.
主な方法:
- エンドオカルディティス-前向きコホート研究に関する国際協力からのデータの分析.
- 感染性エンドカルディティスとHFの既知の状態を有する4075人の患者を含む.
- 病院での死亡率と1年後の死亡率の調査.
主要な成果:
- HFはIE患者の33.4%に存在し,66.7%が重症症状 (NYHAクラスIII/IV) を経験しました.
- バルブ手術は,入院中にHF患者の61.7%で行われました.
- 手術は,病院での (20.6%対44.8%) と1年 (29.1%対58.4%) の死亡率を大幅に低下させた.
結論:
- IEにおけるHFの重症度は,外科介入と死亡率と強く関連しています.
- HFのIE患者におけるバルブ手術は,生存率を改善します.
- 年齢,併発症,感染タイプ,合併症などの要因は,独立して死亡率を予測します.
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