Department of Anesthesiology, Hamamatsu Medical Center, 328 Tomizuka, Hamamatsu 432-8580, Japan.
J Anesth. 2010 Oct;24(5):733-8. doi: 10.1007/s00540-010-0969-3. Epub 2010 Jun 15.
Perioperative ischemic stroke occurs in approximately 0.08-0.7% of patients after non-cardiovascular surgery and confers a significant risk of morbidity and mortality. The mortality rate of this major complication is similar in non-cardiovascular and cardiovascular surgery. Its incidence appears to be similar in Japan, Europe, and the United States. Perioperative physicians should be aware of the pathophysiology and predictors of ischemic stroke, and the anti-thrombotic strategies to prevent it. The main causes of perioperative ischemic stroke include cerebral atherothrombosis; lacuna stroke; cardiac thrombi due to atrial fibrillation; dehydration; hypotension; and perioperative systemic hypercoagulability. Perioperative management includes detailed informed consent regarding potential stroke risks, counseling, careful surgical treatment decisions, and identification of the high-risk patient for perioperative antithrombotic strategies. The 2009 Japanese guidelines for the management of stroke recommend using the appropriate intravenous infusions to avoid dehydration and consideration of anticoagulation in the patients who are at high risk for thrombosis and embolism while antithrombotic agents are discontinued. Understanding how to prevent perioperative ischemic stroke remains a challenge. In this article, we review the incidence, timing of the occurrence, mortality, risk factors, and pathophysiology of perioperative ischemic stroke in the non-cardiovascular surgery patient.
围手术期缺血性卒中在非心血管手术后患者中的发生率约为 0.08-0.7%，并带来显著的发病率和死亡率风险。这种主要并发症在非心血管手术和心血管手术中的死亡率相似。其发病率在日本、欧洲和美国似乎相似。围手术期医生应了解缺血性卒中的病理生理学和预测因素，以及预防其发生的抗血栓策略。围手术期缺血性卒中的主要原因包括脑动脉粥样硬化血栓形成；腔隙性卒中；由于心房颤动导致的心脏血栓；脱水；低血压；以及围手术期全身高凝状态。围手术期管理包括详细的关于潜在卒中风险的知情同意、咨询、仔细的手术治疗决策，以及识别高风险患者进行围手术期抗血栓策略。2009 年日本卒中管理指南建议使用适当的静脉输液以避免脱水，并在停止使用抗血栓药物时考虑对有高血栓和栓塞风险的患者进行抗凝治疗。了解如何预防围手术期缺血性卒中仍然是一个挑战。在本文中，我们回顾了非心血管手术患者围手术期缺血性卒中的发生率、发生时间、死亡率、危险因素和病理生理学。
