【摘要】：目的:系統(tǒng)評(píng)價(jià)生物瓣與機(jī)械瓣治療感染性心內(nèi)膜炎的預(yù)后,為臨床治療提供指導(dǎo)。方法:在PubMed、Cochrane、Embase、萬(wàn)方、知網(wǎng)數(shù)據(jù)庫(kù)中收集生物瓣與機(jī)械瓣治療感染性心內(nèi)膜炎的臨床研究,文獻(xiàn)檢索時(shí)間從1960年1月至2016年11月公開(kāi)發(fā)表的論文,根據(jù)NOS量表評(píng)價(jià)納入文獻(xiàn)的質(zhì)量并提取數(shù)據(jù)資料,采用Stata 12.0軟件進(jìn)行Meta分析。結(jié)果:最終納入11篇文獻(xiàn),共入選病例10754例,其中生物瓣組6776例,機(jī)械瓣組3978例。研究分析結(jié)果顯示,生物瓣組全因死亡率高于機(jī)械瓣組(合并HR=1.22,95%CI:1.03~1.44,p=0.023),差異有統(tǒng)計(jì)學(xué)意義;生物瓣組術(shù)后早期死亡率高于機(jī)械瓣組(合并RR=1.21,95%CI:1.02~1.43,p=0.033),差異有統(tǒng)計(jì)學(xué)意義;生物瓣組術(shù)后感染性心內(nèi)膜炎復(fù)發(fā)率明顯高于機(jī)械瓣組(合并HR=1.75,95%CI:1.26~2.42,p=0.001),差異有統(tǒng)計(jì)學(xué)意義;生物瓣組再次手術(shù)率高于機(jī)械瓣組(合并HR=1.79,95%CI:1.15~2.80,p=0.010),差異有統(tǒng)計(jì)學(xué)意義;生物瓣組術(shù)后栓塞發(fā)生率小于機(jī)械瓣組(合并RR=0.90,95%CI:0.76~1.07,p=0.245),差異無(wú)統(tǒng)計(jì)學(xué)意義。人工瓣膜感染性心內(nèi)膜炎(PVE)患者置入生物瓣術(shù)后死亡率與機(jī)械瓣組相比無(wú)統(tǒng)計(jì)學(xué)差異(合并HR=0.91,95%CI:0.68~1.21,p=0.520)。結(jié)論:感染性心內(nèi)膜炎患者外科手術(shù)治療時(shí),選擇置入機(jī)械瓣可以提供比生物瓣更好的預(yù)后,包括更低的術(shù)后死亡率、復(fù)發(fā)率和再次手術(shù)率。導(dǎo)致這一結(jié)果的原因可能是納入研究中兩組患者基本情況的差異,而非瓣膜的功能障礙。
[Abstract]:Objective: to evaluate the prognosis of biological valve and mechanical valve in the treatment of infective endocarditis and to provide guidance for clinical treatment. Methods: clinical studies on the treatment of infective endocarditis with bivalve and mechanical valve were collected in PubMed,Cochrane,Embase, Wanfang, intellectual Web database. The literature was retrieved from January 1960 to November 2016. According to the NOS scale, the quality of the documents was evaluated and the data were extracted. The Meta analysis was carried out with Stata 12.0 software. Results: 10754 cases were enrolled in 11 literatures, including 6776 cases in bio-flap group and 3978 cases in mechanical valve group. The results showed that all-cause mortality in the biological valve group was higher than that in the mechanical valve group (with HR=1.22,95%CI:1.03~1.44,p=0.023), and the difference was statistically significant. The early postoperative mortality in the bio-valve group was higher than that in the mechanical valve group (with RR=1.21,95%CI:1.02~1.43,p=0.033), the difference was statistically significant. The recurrence rate of infective endocarditis in the bivalve group was significantly higher than that in the mechanical valve group (with HR=1.75,95%CI:1.26~2.42,p=0.001), the difference was statistically significant. The rate of re-operation in the biological valve group was higher than that in the mechanical valve group (with HR=1.79,95%CI:1.15~2.80,p=0.010), the difference was statistically significant. The incidence of embolization in the bio-valve group was lower than that in the mechanical valve group (with RR=0.90,95%CI:0.76~1.07,p=0.245), and there was no significant difference between the two groups. There was no significant difference in mortality between patients with prosthetic valvular infective endocarditis (PVE) and mechanical valve group (combined with HR=0.91,95%CI:0.68~1.21,p=0.520). Conclusion: when surgical treatment of infective endocarditis patients, mechanical valve placement can provide a better prognosis than biological valve, including lower postoperative mortality, recurrence rate and re-operation rate. This result may be due to the difference in basic conditions between the two groups of patients in the study, not valvular dysfunction.
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R654.2

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本文編號(hào)：2448201