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首页> 外文期刊>Journal of cardiac surgery. >Management of Septic emboli in patients with infectious endocarditis
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Management of Septic emboli in patients with infectious endocarditis

机译：感染性心内膜炎患者脓毒症栓塞的管理

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Abstract Background and Aim Septic emboli (SE) associated with infectious endocarditis (IE) can result in splenic abscesses and infectious intracranial aneurysms (IIA). We investigated the impact of SE on patient outcomes following surgery for IE. Method From January‐2000 to October‐2015, all patients with surgical IE (n?=?437) were evaluated for incidence and management of SE. Results Overall SE was found in 46/437 (10.52%) patients (n?=?17 spleen, 13 brain, and 16 both). No mortality was seen in the brain emboli groups, but in the splenic abscess group the in‐hospital mortality was 8.69% (n?=?4); and was associated with Age 35 (OR?=?2.63, 1.65‐4.20) and congestive heart failure (OR?=?14.40, 1.23‐168.50). Patients with splenic emboli had excellent mid‐term outcome following discharge (100% survival at 4‐years). Splenic emboli requiring splenectomy was predicted by a 20?mm valve vegetation (OR?=?1.37, 1.056‐1.77) and WBC 12000?cells/mm (OR?=?5.58, 1.2‐26.3). No patient with streptococcus‐viridians infection had a nonviable spleen (OR?=?0.67, 0.53‐0.85). Postoperative acute‐kidney‐injury was higher in the splenectomy group (45.45% vs 9%) (p?=?0.027). There were 6 patients with symptomatic IIAs that required coiling/clipping which was associated with age 30 years, (OR?=?6.09, 1.10‐33.55). Survival in patients with cerebral emboli decreased to 78% at 3‐4 years. Patients with both splenic and brain emboli had a 92% survival rate at 1‐year and 77% at 2‐4 years. Conclusion Septic emboli is common in endocarditis patients. Patients with high preoperative WBC level and large valve vegetations require CT imaging of the spleen. Both spleen and brain interventions in the setting of IE can be performed safely with excellent early and mid‐term outcomes.
机译：摘要背景和目的与传染性内膜炎（即）相关的症状栓塞（IE）可以导致脾脓肿和传染性颅内动脉瘤（IIa）。我们调查了SE对IE手术后患者结果的影响。方法从1月 - 2000年到2015年10月 - 2015年10月，所有患者的外科患者（n？=Δ337）被评估了SE的发病率和管理。结果在46/437（10.52％）患者（N？= 17脾，13脑和16次）中发现了整体硒。在脑栓子群中没有看到死亡率，但在脾脓肿组中，住院治疗的死亡率为8.69％（n？=？4）;并且与年龄有关，与年龄相关联35（或？=？2.63,1.65-4.20）和充血性心力衰竭（或？=？= 14.40,1.23-168.50）。脾脏栓塞患者在出院后具有优异的中期结果（4年的100％存活）。需要脾切除术的脾栓塞被A＆ 20？mm阀门植被（或？=？1.37,1.056-1.77）和WBC＆ 12000？细胞/ mm（或？=？5.58,1.2-26.3）。没有患有链球菌的患者感染脾脏（或？= 0.67,0.53-0.85）。脾切除术中术后急性肾损伤较高（45.45％vs 9％）（p？= 0.027）。有6例患有症状性症状的患者，需要卷曲/削片，其与年龄＆ 30岁相关，（或？=？6.09,1.10-33.55）。脑栓塞患者的生存率在3 - 4年内降至78％。脾脏和脑栓塞患者在1年的生存率为92％，2-4岁以上77％。结论脓毒症栓子在心内膜炎患者中常见。高术前WBC水平和大型瓣膜植被的患者需要CT成像脾脏。在IE的环境中的脾脏和脑干干预均可安全地以优异的早期和中期结果进行安全。

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