Risk factors for perioperative stroke in aged patients undergoing nonneurologic and noncardiovascular surgery

目的 评估老年患者非神经外科非心血管手术围术期脑卒中的发生率、危险因素及预后.方法 选取2010年1月至2016年5月于北京大学人民医院接受非神经外科非心血管手术治疗的年龄≥65岁的住院患者21 419例.依据患者是否发生围术期脑卒中,分为脑卒中组(n=22)及非脑卒中组(n=21 397).对比2组患者的一般资料、合并疾病、术前实验室检查、手术麻醉资料及预后.行多因素Logistic回归分析该人群围术期脑卒中的危险因素.结果 22例(0.1％)患者发生围术期脑卒中.该人群围术期脑卒中的独立危险因素包括:美国医师协会(ASA)分级(P=0.031,OR=2.395,95％ CI:1.082～5.301),既往脑卒中或短暂性脑缺血发作(TIA)病史(P＜0.001,OR=61.305,95％CI:19.311～194.617),需胰岛素治疗的糖尿病(P=0.015,OR=3.488,95％CI:1.275 ～9.540),颈动脉狭窄(P=0.001,OR=15.157,95％ CI:3.068～74.885)及术前贫血(P=0.032,OR=3.272,95％CI:1.108～9.662).围术期脑卒中组及非脑卒中组患者住院时间分别为30(23,55)d及10(6,17)d,差异有统计学意义(Z =3.302,P＜0.001).脑卒中组及非脑卒中组患者死亡率分别为18.2％及0.1％,差异有统计学意义(P＜0.001).结论 老年患者非神经外科非心血管手术的围术期脑卒中的独立预测因素包括ASA分级、既往脑卒中史或TIA病史、需胰岛素治疗的糖尿病、颈动脉狭窄及术前贫血.具有此类因素的患者应给予更精细化的围术期管理.Objective To assess the incidence,risk factors,and outcomes of perioperative stroke in aged patients undergoing nonneurologic and noncardiovascular surgery.Methods A total of 21 419 in-patients who were older than 65 years undergoing nonneurologic and noncardiovascular surgery in Peking University People's Hospital from January 2010 to May 2016 were retrospectively recruited in this study.The patients were divided into two groups:patients with perioperative stroke were allocated in stroke group,and the other patients were in the non-stroke group.The following variables were compared between the 2 groups:demographics,comorbidities,preoperative laboratory tests,characteristics of operation and anesthesia and prognosis.A multivariate Logistic regression was used to evaluate the risk factors for perioperative stroke in aged patients undergoing nonneurologic and noncardiovascular surgery.Results Stroke occurred in twenty-two patients (0.1％),and the risk factors were:American Society of Anesthesiologists (ASA) classification (P =0.031;OR =2.395;95％ CI:1.082-5.301),previous stroke or transient ischemic attack (P ＜ 0.001;OR =61.305;95 ％ CI:19.311-194.617),diabetes on insulin (P =0.015;OR =3.488;95 ％ CI:1.275-9.540),carotid stenosis (P =0.001;OR =15.157;95％ CI:3.068-74.885) and preoperative anemia (P =0.032;OR =3.272;95％ CI:1.108-9.662).Perioperative stroke led to prolong the hospital stay from 10 (6,17) days to 30 (23,55) days (Z =3.302,P ＜ 0.001).The mortality was 18.2％ in the stroke group and 0.1％ in those without perioperative stroke (P ＜0.001).Conclusion The independent predictors of stroke in this population are ASA classification,previous stroke or transient ischemic attack,diabetes on insulin,carotid stenosis and preoperative anemia.Patients with these characteristics deserve more carefully perioperative management.中文核心期刊要目总览(PKU)中国科技核心期刊(ISTIC)中国科学引文数据库(CSCD)433454-34589