摘要
目的探讨围术期缺血性脑卒中的危险因素,为脑卒中的预防提供依据。方法选择2005年1月~2011年12月在我院神经内科行非心脏和非血管外科手术,经MRI确诊为围术期缺血性脑卒中患者54例(病例组),同期随机选择围术期未发生脑卒中患者162例(对照组),采用13配对病例研究设计,收集2组患者的临床资料,分别行单因素、多因素logistic回归分析。结果病例组术中血压下降比例明显高于对照组(33.3%vs 19.8%,P=0.038),高血压、糖尿病、心脏病、慢性肾脏病、脑血管病、心房颤动、白细胞计数、肌酐水平明显低于对照组[22.2%vs37.0%,P=0.047;14.8%vs 29.6%,P=0.032;18.5%vs 32.1%,P=0.025;11.1%vs 33.3%,P=0.001;20.4%vs 32.7%,P=0.000;22.2%vs 37.7%,P=0.046;(10.67±4.92)×109/L vs(14.39±6.18)×109/L,P=0.042;(78.92±2.87)μmol/L vs(108.00±3.21)μmol/L,P=0.002]。logistic回归分析表明,术中血压下降(OR=9.594,95%CI:3.338~27.575,P=0.000)、高血压(OR=9.219,95%CI:2.945~28.856,P=0.000)、慢性肾脏病(OR=6.096,95%CI:1.782~20.858,P=0.004)、脑血管病(OR=3.870,95%CI:1.008~14.860,P=0.049)、心房颤动(OR=3.225,95%CI:1.128~9.219,P=0.029)为围术期缺血性脑卒中的危险因素。结论术中血压下降、高血压、慢性肾脏病、脑血管病、心房颤动可能为非心脏和非血管外科手术围术期缺血性脑卒中独立预测因素。
Objective To provide the evidence for preventing perioperative ischemic stroke by studying its risk factors.Methods Fifty-four perioperative ischemic stroke patients served as an ischemic stroke group and 162 patients who did not have perioperative ischemic stroke served as a control group in this study.Their clinical data were analyzed by univariate analysis and multivariate analysis respectively.Results The blood pressure was significantly higher while the incidence of hypertension,diabetes,heart disease,chronic renal disease,cerebrovascular disease and AF was significantly lower,the number of WBC was significantly less,and the serum creatinine level was significantly lower in ischemic stroke group than in control group（33.3%vs 19.8%,P=0.038;22.2%vs 37.0%,P=0.047;14.8% vs 29.6%,P=0.032;18.5% vs 32.1%,P=0.025;11.1%vs 33.3%,P=0.001;20.4%vs 32.7%,P=0.000;22.2%vs 37.7%,P=0.046;10.67±4.92×10^9/L vs 14.39±6.18×10^9/L,P=0.042;78.92±2.87μmol/L vs 108.00±3.21μmol/L,P=0.002）.Logistic regression analysis showed that intraoperative blood pressure,chronic renal disease,cerebrovascular disease and AF were independent risk factors for perioperative ischemic stroke（OR=9.594,95%CI：3.338-27.575;OR=9.219,95%CI：2.945-28.856;OR=6.096,95%CI：1.782-20.858;OR=3.870,95%CI：1.008-14.860;OR=3.225,95%CI：1.128-9.219）.Conclusion Intraoperative blood pressure,chronic renal disease,cerebrovascular disease and AF are the independent risk factors for perioperative ischemic stroke.
作者
颜晓晓
林勉
张顺开
邵蓓
YAN Xiao-xiao LIN Mian ZHANG Shun-kai et al(Department of Neurology, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou 325200, Zhej iang Province, Chin)
出处
《中华老年心脑血管病杂志》
CAS
2017年第3期292-295,共4页
Chinese Journal of Geriatric Heart,Brain and Vessel Diseases
关键词
手术期间
卒中
高血压
心房颤动
肾病
intraoperative period
stroke
hypertension
atrial fibrillation
nephrosis
