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门手术对左侧感染性内心炎6个月死亡率的影响
Imad M Tleyjeh1, Hassan M K Ghomrawi, James M Steckelberg
1Division of Infectious Diseases, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minn, USA. tleyjeh.imad@mayo.edu
Circulation
|March 21, 2007
概括
左侧传染性内心炎的门手术没有显示生存益处,可能会增加死亡率. 需要进一步的前性研究来澄清手术在心内膜炎管理中的作用.
科学领域:
- 心脏病学 心脏病学
- 传染性疾病 传染性疾病
- 外科手术的结果
背景情况:
- 左侧传染性内心炎带来严重的死亡风险.
- 在这种情况下,门手术的作用缺乏通过随机对照试验进行评估.
- 这项研究调查了感染性内心炎患者的门手术和死亡率之间的关联.
研究的目的:
- 研究左侧感染性内心炎患者的门手术和6个月全因死亡率之间的关联.
- 为了调整潜在的偏差,包括选择偏差和幸存者偏差.
- 为临床决策提供有关感染性内心炎手术干预的证据.
主要方法:
- 分析了546名患有左侧传染性内心炎的患者队列.
- 倾向性得分匹配被用来尽量减少手术和非手术组之间的选择偏差.
- 考克斯模型,包括时间依赖的共变量和分区分析,用于评估死亡风险.
主要成果:
- 129名患者 (23.6%) 进行了门手术.
- 最初的分析显示,与手术相关的6个月死亡率可能会增加 (调整后的危险比率,1.9).
- 在调整了手术死亡率后,门手术与生存益处无关 (调整后的危险比率为0.92).
结论:
- 左侧传染性内心炎的门手术与改善的存活率无关.
- 该程序可能与6个月死亡率的增加有关,即使在偏差调整后.
- 进一步的精心设计的前性研究对于确定门手术在心内膜炎管理中的最佳作用至关重要.
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