Risk Factors and Stroke Characteristic in Patients with Postoperative Strokes
Risk Factors and Stroke Characteristic in Patients with Postoperative Strokes
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DOI：
10.1016/j.jstrokecerebrovasdis.2016.12.017
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发表时间：
2017-07-01
影响因子：
2.5
通讯作者：
Dong, Qiang
中科院分区：
文献类型：
--
作者：
Dong, Yi;Cao, Wenjie;Dong, Qiang
背景：静脉溶栓和动脉血栓切除术现在是急性缺血性卒中患者的标准治疗方法。即使在中风中心，内部中风也经常被忽视，并且对于如何管理它们没有达成共识。围手术期脑卒中发生率较高，但缺乏治疗方案，在中国，内部脑卒中的问题尚未探讨。本研究的目的是探讨目前的管理内部中风，并确定常见的危险因素与围手术期中风。方法：总共有51，841名患者入住上海一家三级医院，并审查了那些因中风而接受神经科咨询的患者的记录。他们的人口统计学，临床特征，住院并发症和手术，和管理计划进行了前瞻性研究。采用多因素Logistic回归模型分析常规实验室检查结果及危险因素。结果：从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例发生了内部卒中，20例在术后期间发生了更严重的卒中。与没有手术或操作的住院卒中患者相比，白细胞增多和空腹血糖水平升高在围手术期卒中中更常见。在多元Logistic回归模型中，围手术期卒中更可能与大血管闭塞相关。结论：围手术期脑卒中患者与其他院内脑卒中患者有不同的危险因素和严重程度。对于这些患者，在手术前获得神经科会诊可能是适当的，以评估围手术期卒中的风险。
Background: 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. Method: 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. Result: 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. Conclusion: 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.