Dong Yi, Cao Wenjie, Cheng Xin, Fang Kun, Zhang Xiaolong, Gu Yuxiang, Leng Bing, Dong Qiang
Department of Neurology, Fudan University, Huashan Hospital, Shanghai, China; State Key Laboratory of Neurobiology, Fudan University, Shanghai, China.
Department of Neurology, Fudan University, Huashan Hospital, Shanghai, China; State Key Laboratory of Neurobiology, Fudan University, Shanghai, China.
J Stroke Cerebrovasc Dis. 2017 Jul;26(7):1635-1640. doi: 10.1016/j.jstrokecerebrovasdis.2016.12.017. Epub 2017 May 3.
Intravenous thrombolysis and intra-arterial thrombectomy are now the standard therapies for patients with acute ischemic stroke. In-house strokes have often been overlooked even at stroke centers and there is no consensus on how they should be managed. Perioperative stroke happens rather frequently but treatment protocol is lacking, In China, the issue of in-house strokes has not been explored. The aim of this study is to explore the current management of in-house stroke and identify the common risk factors associated with perioperative strokes.
Altogether, 51,841 patients were admitted to a tertiary hospital in Shanghai and the records of those who had a neurological consult for stroke were reviewed. Their demographics, clinical characteristics, in-hospital complications and operations, and management plans were prospectively studied. Routine laboratory test results and risk factors of these patients were analyzed by multiple logistic regression model.
From January 1, 2015, to December 31, 2015, over 1800 patients had neurological consultations. Among these patients, 37 had an in-house stroke and 20 had more severe stroke during the postoperative period. Compared to in-house stroke patients without a procedure or operation, leukocytosis and elevated fasting glucose levels were more common in perioperative strokes. In multiple logistic regression model, perioperative strokes were more likely related to large vessel occlusion.
Patients with perioperative strokes had different risk factors and severity from other in-house strokes. For these patients, obtaining a neurological consultation prior to surgery may be appropriate in order to evaluate the risk of perioperative stroke.
静脉溶栓和动脉内取栓目前是急性缺血性脑卒中患者的标准治疗方法。即使在卒中中心，院内卒中也常常被忽视，对于如何管理这类卒中尚无共识。围手术期卒中相当常见，但缺乏治疗方案。在中国，院内卒中问题尚未得到探讨。本研究的目的是探讨当前院内卒中的管理情况，并确定与围手术期卒中相关的常见危险因素。
共有51841名患者入住上海一家三级医院，对其中因卒中进行神经科会诊的患者记录进行回顾。前瞻性研究他们的人口统计学、临床特征、院内并发症和手术情况以及管理计划。通过多因素逻辑回归模型分析这些患者的常规实验室检查结果和危险因素。
2015年1月1日至2015年12月31日，超过1800名患者进行了神经科会诊。在这些患者中，37例发生了院内卒中，20例在术后发生了更严重的卒中。与未进行手术的院内卒中患者相比，围手术期卒中患者白细胞增多和空腹血糖水平升高更为常见。在多因素逻辑回归模型中，围手术期卒中更可能与大血管闭塞有关。
围手术期卒中患者与其他院内卒中患者的危险因素和严重程度不同。对于这些患者，术前进行神经科会诊以评估围手术期卒中风险可能是合适的。
