Retrospective Analysis Of Perioperative Risk Factors Of Stroke In Thoracic Surgery

Objective To analyze the risk factors of perioperative stroke(PS)in patients undergoing thoracic surgery and to guide perioperative anesthesia management so as to reduce the incidence and improve the prognosis of patients.Methods Approved by the Ethics Committee of Second Affiliated Hospital of Da Lian Medical University,Patients who underwent thoracic surgery in the hospital from October 1,2014 to October 1,2019 were selected for the study.Using the electronic case system and anesthesia system,choosing the patient who has neurological impairment such as dyskinesia,inarticulate speech and disturbance of consciousness during the perioperative period,and underwent CT/MRI examination,diagnosed as PS after consultation by a neurologist as Case group.Using the method of case-control study,according to the ratio of case group to control group at 1:4,the patients with the same type of operation in the same department but no perioperative stroke in the same period were selected as the control group.The general condition,past medical history,operation method,anesthesia method,American association of anesthesiologists grade,use of PCEA,operation time,anesthesia time,intraoperative hypotension,intraoperative lens intake,colloid volume,bleeding volume and urine volume,postoperative intake and discharge,and preoperative laboratory examination were collected from the two groups.Logistic regression model was used to analyze the risk factors of perioperative stroke in patients undergoing thoracic surgery.Results 1.Incidence: among the 5869 cases,there were 9 patients with perioperative stroke,with an incidence of 0.153%,including 2 males(22.2%)and 7 females(77.8%),all aged between 61 and 83 years old.2.Types of stroke: ischemic stroke in 7 cases(77.8%),hemorrhagic stroke in 1 case(11.1%),infarction with hemorrhage in 1 case(11.1%).3.The time of occurrence of perioperative stroke in the case group: the results showed that 4 cases(44.4%)occurred on the first day after operation,and the other 5 cases(55.6%)occurred on the day after operation and on the 2nd,3rd,5th and 11 th day after operation,respectively.4.Risk factors: univariate Logistic analysis showed that history of hypertension,previous stroke,advanced age,general anesthesia combined with epidural anesthesia,postoperative PCEA analgesia,intraoperative hypotension and increased FIB were associated with perioperative stroke,while multivariate Logistic analysis showed that history of hypertension and previous stroke were independent risk factors of perioperative stroke.5.The median length of stay in stroke group and non-stroke group was 20.0 days and 10.5 days,respectively.The occurrence of stroke significantly prolonged the length of stay in patients,and the difference was statistically significant(p<0.05).6.The outcome of the stroke group: 2 cases were cured(22.2%),4 cases improved or had mild sequelae(44.4%),2 cases had severe sequelae(22.2%),and 1 case died(11.1%).Conclusion 1.Independent risk factors of perioperative stroke in thoracic surgery: history of hypertension,previous history of stroke;2.Risk factors of perioperative stroke in thoracic surgery: advanced age,general anesthesia combined with epidural anesthesia,postoperative use of PCEA analgesia,intraoperative hypotension,increased FIB.3.The occurrence of perioperative stroke significantly prolonged the hospitalization time of patients.According to the above results,we can formulate anesthesia management plan to prevent and reduce the occurrence of perioperative stroke and improve the prognosis of patients.