Hindman B J
Int Anesthesiol Clin. 1986 Winter;24(4):101-34. doi: 10.1097/00004311-198602440-00008.
This chapter reviewed the mechanisms and manifestations of transient and irreversible cerebral ischemia and the current experimental approaches to attenuate ischemic neuronal injury. Patients with signs or symptoms of cerebral ischemia are likely to have abnormal cerebrovascular dynamics, with areas of cerebrum at risk, and may be at an increased risk of stroke after general or vascular surgery. Such patients also have a very high frequency of associated cardiac disease. In this chapter, guidelines for anesthetic management of patients with symptomatic CVD undergoing noncardiac surgery were based on current understanding of the pathophysiology of cerebral ischemia. Nonetheless, the available data indicate that most perioperative strokes occur in the postoperative period and appear to be thromboembolic in nature. The existence of neither asymptomatic carotid bruits nor intraoperative hypotension appears to be associated with the occurrence of perioperative stroke.
本章回顾了短暂性和不可逆性脑缺血的机制与表现，以及目前减轻缺血性神经元损伤的实验方法。有脑缺血体征或症状的患者可能存在脑血管动力学异常，大脑某些区域处于危险之中，并且在接受全身手术或血管手术后发生中风的风险可能会增加。这类患者还伴有心脏病的频率非常高。在本章中，针对有症状性心血管疾病的患者进行非心脏手术的麻醉管理指南是基于目前对脑缺血病理生理学的理解制定的。尽管如此，现有数据表明，大多数围手术期中风发生在术后，并且本质上似乎是血栓栓塞性的。无症状性颈动脉杂音和术中低血压的存在似乎均与围手术期中风的发生无关。
