Vasivej Thadpaveen, Sathirapanya Pornchai, Kongkamol Chanon
Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
J Stroke Cerebrovasc Dis. 2016 May;25(5):1172-1176. doi: 10.1016/j.jstrokecerebrovasdis.2016.01.051. Epub 2016 Feb 24.
Perioperative stroke, defined as a stroke that occurs during an operation until 30 days postoperatively, is an uncommon but devastating complication. Studies regarding perioperative stroke in noncardiac and nonmajor vessels surgery are scarce.
Patients aged 18 years and older who underwent noncardiac, and nonaortic and its major branches surgery between January 2009 and December 2013 were included. A surgeon-matched control study forming a case-to-control ratio of 1:4 was conducted. Patients' characteristics, comorbidities, preoperative and perioperative stroke risks, stroke types, and types of surgical procedure were collected and analyzed by descriptive statistics. Multiple logistic regression analysis was used to identify significant risk factors of perioperative strokes (P <.05).
Forty-two out of 55,648 noncardiovascular surgery patients developed perioperative strokes, resulting in an incidence of .075%. Age (adjusted OR 1.04; 95% CI 1-1.08, P = .42), valvular heart disease (adjusted OR 6.18; 95% CI 1.35-28.33, P = .019), previous stroke (adjusted OR 7.06; 95% CI 1.74-28.75, P = .006), emergency surgery (adjusted OR 8.13; 95% CI 2.05-32.25, P = .003), and postoperative hypotension (adjusted OR 5.1; 95% CI 1.11-23.45, P = .036) were significant predictors of perioperative strokes by multivariable analysis.
The incidence of perioperative stroke found was comparable to the previous similar studies. Advanced age, pre-existing valvular heart disease, previous stroke, emergency surgery, and postoperative hypotension were the significant risk factors determined in this study.
围手术期卒中定义为手术期间直至术后30天内发生的卒中，是一种罕见但具有毁灭性的并发症。关于非心脏和非大血管手术围手术期卒中的研究很少。
纳入2009年1月至2013年12月期间接受非心脏、非主动脉及其主要分支手术的18岁及以上患者。进行了一项外科医生匹配的对照研究，病例与对照比例为1:4。收集患者的特征、合并症、术前和围手术期卒中风险、卒中类型以及手术类型，并通过描述性统计进行分析。采用多因素logistic回归分析确定围手术期卒中的显著危险因素（P <.05）。
55648例非心血管手术患者中有42例发生围手术期卒中，发生率为0.075%。年龄（校正比值比1.04；95%可信区间1 - 1.08，P = 0.42）、瓣膜性心脏病（校正比值比6.18；95%可信区间1.35 - 28.33，P = 0.019）、既往卒中（校正比值比7.06；95%可信区间1.74 - 28.75，P = 0.006）、急诊手术（校正比值比8.13；95%可信区间2.05 - 32.25，P = 0.003）以及术后低血压（校正比值比5.1；95%可信区间1.11 - 23.45，P = 0.036）是多因素分析中围手术期卒中的显著预测因素。
本研究中发现的围手术期卒中发生率与先前类似研究相当。高龄、既往瓣膜性心脏病、既往卒中、急诊手术以及术后低血压是本研究确定的显著危险因素。
