The Clinical Analysis Of32Perioperative Ischmic Stroke In Noncardiac And Nonvascular Surgery

Purpose： To evaluate the relative risk factors、 main mechanisms ofpathophysiology, and therapy of perioperative ischmic stroke in noncardiac andnonvascular surgery.Methods: Patients occurred new neurological deficits such as Hemiplegia,Patients occurred new neurological deficits such as Hemiplegia,paresthesia,hemianopsia, gaze palsy, nystagmus, aphasia, acalculia, alexia, seizure or consciousdisturbance in the perioperative of noncardiac and nonvascular surgery were enrolledin the study from December1999to December2011in the General Hospital ofShenyang Military. Data of sex,age,Previous history, general state of health onadmission and general surgery condition operation, include: anesthesia, procedures,operation time,intraoperative blood pressure, intraoperative heart rate, bloodbiochemical examination before and after operation(white blood cells, platelets,fibrinogen),time of occurrence of cerebral infarction,clinical symptoms,NIHSSscores,cranial CT and/or MRI+DWI examination results were recorded,length of stayand so on.Results: A total of32patients occurred cerebral infarction in the perioperativeperiod.There were23males and9females. Age33-84years old,average67.72±10.69years old.17patients have previous stroke:TIA in1cases,cerebral infarction in15cases,cerebral hemorrhage in2cases.This group of patients with smoking history in18cases,drinking history in11cases,hypertension in22cases,diabetes in13cases,coronery heart disease in8cases,atrial fibrillation in2cases. This group of32patients:neck surgery in2cases, abdominal surgery in20cases, orthopedic surgery in5cases, urinary surgery in3cases. emergency surgery in11cases, selective surgery in21cases.Anesthesia in21cases, epidural anesthesia in5patients, local anesthesia in6 patients.time of occurrence of cerebral infarction:postoperative day in2patients,1-2day after sugury in11patients,2-3day after sugury in11patients,3-4day after suguryin2patients,4-5day after sugury in2patients,5-6day after sugury in2patients,5-6day after sugury in2patients,6-7day after sugury in1patients,12day after sugury in1patients.This group of32patients appear hemiplegia in23patients, paresthesia in7patients, hemianopsia in2patients, gaze palsy in4patients, nystagmus in2patients,aphasia in2patients, acalculia and alexia in2patients, seizure in1patients, consciousdisturbance in1patients.Peripheral leukocyte count rise after surgery (preoperative:9.08±4.78×109/L vs postoperative:11.67±2.90×109/L, P <0.01). Fibrinogen riseafter surgery (preoperative:3.61±1.12g/L vs postoperative:5.10±1.32g/L, P<0.01).After the head of the CT or MRI/DWI confirmed anterior circulation lesions in28cases,posterior circulation lesions in4cases.This group of patients were treatedwith comprehensive therapy.Given supportive treatment with blood vessels to dilate,blood circulation and brain protection drugs,5patients of massive cerebral infarctiongiven20%mannitol reducing the intracranial pressures.1patient was treated withaspirin antiplatelet therapy,2patients were treated with low molecular weight heparinanticoagulant therapy,1patient was treated with defibrase,1patient was treated withvalpramide antiepilepsy treatment.The length of stay2-69days(20.55±13.35days).Discharged without disability in5cases,mild to moderate disability in14cases,severe disability in11cases and2deaths.Conclusion:1,Preexisting stroke risk factors especially with history ofsmoking,hypertension,TIA,cerebral infarction,cerebral hemorrhage patients moresusceptible to concurrent perioperative stroke.2,Surgery-related risks factors such ashypotension the type of anesthesia and surgery，the surgery itself and postoperativeinfection，stress response and other factors may be riding an important role in theperioperative cerebral infarction in noncardiac and nonvascular surgery.3,This datashowed that postoperative peripheral WBC，PLT，FIB increased compared with thepreoperative,the WBC and FIB were significantly associated with perioperativecerebral infarction.4, perioperative cerebral infarction in noncardiac and nonvascularsurgery is a catastrophic complication after surgery is still a lack of effective treatmentand poor prognosis.