Axelrod David A, Stanley James C, Upchurch Gilbert R, Khuri Shukri, Daley Jennifer, Henderson William, Demonner Sonia, Henke Peter K
Section of Vascular Surgery, Department of Surgery, Robert Wood Johnson Scholars Program, University of Michigan School of Medicine, University Hospital 2210D THCC/0329, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-0329, USA.
J Vasc Surg. 2004 Jan;39(1):67-72. doi: 10.1016/j.jvs.2003.08.028.
Patients undergoing operations to treat peripheral vascular disease have systemic atherosclerosis and are at risk for stroke. However, the incidence and effect of cerebrovascular events on noncarotid vascular surgical outcomes are not well-defined.
Patients undergoing common operations for vascular disease from 1997 to 2000 were examined with data from the Veterans Affairs (VA) National Surgery Quality Improvement Project and the VA patient treatment files. Operations studied included abdominal aortic aneurysmectomy (n = 2551), aortobifemoral bypass (n = 2616), lower extremity bypass (n = 6866), and major lower extremity amputation (n = 7442). The incidence of perioperative stroke was determined, and logistic regression analysis was used to identify independent risk factors for stroke. Logistic and linear regression analyses were used to quantify the effect of postoperative stroke on adjusted mortality and length of stay. Odds ratio (OR) and 95% confidence interval (CI) were defined. P <.05 was considered significant.
Stroke was uncommon after noncarotid vascular procedures, occurring in only 0.4% to 0.6% of patients. Independent risk factors for stroke include preoperative ventilation (OR, 11; 95% CI, 5.0-22.3; P <.001), previous stroke or transient ischemic attack (OR, 4.2; 95% CI, 2.7-6.4; P <.001), postoperative myocardial infarction (OR, 3.3; 95% CI, 1.3-8.7; P =.009), and need to return to the operating room (OR, 2.2; 95% CI, 1.4-3.5; P =.001). Factors that did not appear to be associated with stroke risk included procedure type, diabetes, renal failure, dialysis dependence, number of transfused units of blood, and hypertension. After controlling for other postoperative complications and comorbid conditions, postoperative stroke significantly increased the risk for perioperative mortality (OR, 6.3; 95% CI, 3.4-11.4; P <.001), with similar magnitude as postoperative myocardial infarction (OR, 6.3; 95% CI, 3.9-10.1; P <.001). Stroke was also associated with a 48% increase in overall length of stay.
Stroke after noncarotid peripheral vascular surgery is uncommon, but results in markedly increased mortality and length of stay. Stroke risk is most strongly associated with previous stroke history and greater degree of illness. Patients with these associated conditions deserve particular attention to assessing and medically managing modifiable risk factors.
接受外周血管疾病手术治疗的患者存在全身性动脉粥样硬化，有中风风险。然而，脑血管事件在非颈动脉血管手术结局中的发生率及影响尚不明确。
利用退伍军人事务部（VA）国家手术质量改进项目及VA患者治疗档案中的数据，对1997年至2000年接受常见血管疾病手术的患者进行研究。所研究的手术包括腹主动脉瘤切除术（n = 2551）、主动脉双股动脉搭桥术（n = 2616）、下肢搭桥术（n = 6866）以及下肢大截肢术（n = 7442）。确定围手术期中风的发生率，并采用逻辑回归分析来识别中风的独立危险因素。运用逻辑回归和线性回归分析来量化术后中风对调整后死亡率及住院时间的影响。定义比值比（OR）和95%置信区间（CI）。P <.05被视为具有统计学意义。
非颈动脉血管手术后中风并不常见，仅0.4%至0.6%的患者发生中风。中风的独立危险因素包括术前通气（OR，11；95% CI，5.0 - 22.3；P <.001）、既往中风或短暂性脑缺血发作（OR，4.2；95% CI，2.7 - 6.4；P <.001）、术后心肌梗死（OR，3.3；95% CI，1.3 - 8.7；P =.009）以及需要返回手术室（OR，2.2；95% CI，1.4 - 3.5；P =.001）。似乎与中风风险无关的因素包括手术类型、糖尿病、肾衰竭、透析依赖、输血单位数量以及高血压。在控制了其他术后并发症和合并症后，术后中风显著增加了围手术期死亡风险（OR，6.3；95% CI，3.4 - 11.4；P <.001），其严重程度与术后心肌梗死相似（OR，6.3；95% CI，3.9 - 10.1；P <.001）。中风还与总住院时间增加48%相关。
非颈动脉外周血管手术后中风并不常见，但会导致死亡率和住院时间显著增加。中风风险与既往中风史及病情严重程度关联最为紧密。患有这些相关疾病的患者在评估和医学管理可改变的危险因素时应受到特别关注。
