Song Hong-song, Fan Dong-sheng
Department of Neurology, Peking University the Third Hospital, Beijing 100191, China.
Zhonghua Nei Ke Za Zhi. 2012 Mar;51(3):217-9.
To investigate the pathogenesis of cerebral infarction after non-cardiac surgeries according to imaging.
Retrospective analyses of clinical and imaging data of 17 patients with postoperative cerebral infarction (average 68 years old, total incidence 0.049%) from departments of orthopedics and general surgery were conducted during 52 months.
Cerebral infarction occurred 39.1 hours after operation on average. Among the 17 patients, eight were detected with disturbance of consciousness, ten with hemiplegia, six with speech disorder and two with unilateral sensory disturbance. Six (35.3%) had blood lipids tests. Five (29.4%) had neck vascular ultrasound and one had intracranial magnetic resonance angiography (MRA). When discharged, one patient was declared death and ten had impaired neurological function in various degrees. Among six patients with previous stroke, one (16.7%) received neurological consultation before surgery. According to the image manifestation, ten cases were territory circulation infarcts, four centrum ovale infarcts and three watershed infarcts.
This study suggests that total incidence of cerebral infarction after non-cardiac surgeries is lower than previously reported and there is greater involvement of atherosclerosis. Patients' conditions should be closely observed within at least four days after surgeries. Preoperative assessment should be strengthened in order to avoid occurrence of postoperative cerebral infarction.
根据影像学研究非心脏手术后脑梗死的发病机制。
对骨科和普通外科52个月期间17例术后脑梗死患者（平均68岁，总发病率0.049%）的临床和影像学资料进行回顾性分析。
脑梗死平均发生在术后39.1小时。17例患者中，8例出现意识障碍，10例偏瘫，6例言语障碍，2例单侧感觉障碍。6例（35.3%）进行了血脂检查。5例（29.4%）进行了颈部血管超声检查，1例进行了颅内磁共振血管造影（MRA）。出院时，1例患者死亡，10例有不同程度的神经功能损害。在6例既往有中风史的患者中，1例（16.7%）在手术前接受了神经科会诊。根据影像学表现，10例为区域循环梗死，4例为卵圆中心梗死，3例为分水岭梗死。
本研究表明，非心脏手术后脑梗死的总发病率低于先前报道，动脉粥样硬化的累及程度更高。术后至少四天内应密切观察患者情况。应加强术前评估，以避免术后脑梗死的发生。
