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患有传染性内心炎,神经并发症和心脏手术的迹象的危急病患者:多中心倾向调整的研究

Alexandre Gros¹, Benjamin Seguy², Guillaume Bonnet²

¹Service de Médecine Intensive Réanimation, CHU de Bordeaux, 33000, Bordeaux, France.

Annals of intensive care

|February 2, 2024

概括

手术显著改善神经结果,并降低严重传染性内心炎 (IE) 患者中风的死亡率. 早期或延迟的心脏手术为这些关键病例提供了比单独治疗医疗更好的结果.

科学领域:

心脏病学心脏病学
神经学神经学
关键护理医学关键护理医学

背景情况:

严重的传染性内心炎 (IE) 具有显著的风险,特别是当中风复杂化时.
最佳的管理策略,平衡手术干预与同时发生脑性事件的IE的医疗治疗,仍然不清楚.

研究的目的:

为了比较经过手术的严重IE和脑并发症患者与仅接受医疗治疗的患者的神经结果.
评估手术对这种高风险患者群体的长期死亡率的影响.

主要方法:

一项前性多中心ICU研究包括192名左侧IE患者,心脏手术的指示,以及先前存在的大脑并发症 (缺血性中风或出血性损伤).
患者被分为医学治疗 (n=67) 或心脏手术 (n=125) 组.
使用倾向性得分调整后勤回归和考克斯模型来分析6个月后的神经结果和1年后的死亡率.

主要成果:

心脏外科手术与显著有利的6个月神经结果相关 (OR 13.8).
手术显著降低了1年死亡率 (HR 0.18).
无论手术时间 (延迟或即时) 或患者的意识水平 (格拉斯哥昏迷表得分) 如何,都观察到这些益处.

结论:

在重症患者中,严重的IE和先前的大脑事件,心脏手术与医疗管理相比,与改善的神经结果有关.
在中风的IE患者中,手术干预提供了生存优势和更好的神经恢复.

关键词:

心脏外科手术是一项心脏手术.内心内膜炎是一种内心内膜炎.血流性中风血流性中风重症监护室的重症监护室是重症监护室的重症监护室.缺血性中风是因为缺血性中风.

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