Department of Anesthesia & Perioperative Care, University of California, San Francisco, San Francisco, California 94143, USA.
Anesthesiology. 2011 Oct;115(4):879-90. doi: 10.1097/ALN.0b013e31822e9499.
Perioperative stroke after noncardiac, nonneurosurgical procedures is more common than generally acknowledged. It is reported to have an incidence of 0.05-7% of patients. Most are thrombotic in origin and are noted after discharge from the postanesthetic care unit. Common predisposing factors include age, a previous stroke, atrial fibrillation, and vascular and metabolic diseases. The mortality is more than two times greater than in strokes occurring outside the hospital. Delayed diagnosis and a synergistic interaction between the inflammatory changes normally associated with stroke, and those normally occurring after surgery, may explain this increase. Intraoperative hypotension is an infrequent direct cause of stroke. Hypotension will augment the injury produced by embolism or other causes, and this may be especially important in the postoperative period, during which monitoring is not nearly as attentive as in the operating room. Increased awareness and management of predisposing risk factors with early detection should result in improved outcomes.
非心脏、非神经外科手术后的围手术期卒中比普遍认为的更为常见。据报道，其发病率为 0.05%-7%的患者。大多数为血栓形成，且发生于麻醉后恢复室出院后。常见的诱发因素包括年龄、既往卒中、心房颤动以及血管和代谢性疾病。其死亡率比医院外发生的卒中高两倍以上。延迟诊断以及与卒中相关的炎症变化以及手术后正常发生的炎症变化之间的协同作用可能解释了这种增加。术中低血压是卒中的罕见直接原因。低血压会加重栓塞或其他原因引起的损伤，这在术后期间可能尤为重要，在此期间的监测不如在手术室中那样密切。提高对诱发风险因素的认识并进行管理，及早发现，应能改善预后。
