围手术期缺血性脑卒中危险因素分析

目的探讨可能引起围手术期缺血性卒中的危险因素。方法收集非心脏、非血管手术围手术期缺血性脑卒中患者的临床资料,用条件Logistic回归做单因素、多因素分析。结果对41例围手术期缺血性脑卒中患者进行回归分析,显示术中血压下降(OR=6.458,95%CI=2.842～13.267)、脑血管病(OR=2.216,95%CI=1.427～5.367)、心房颤动(OR=5.623,95%CI=3.367～8.476)是围手术期缺血性卒中的危险因素。结论对既往有脑血管疾病患者,术中严格维持血压稳定,减少心房颤动发作,对预防围手术期缺血性脑卒中的发生具有重要临床意义。     

烟雾病围手术期卒中危险因素分析

目的 脑血运重建术是目前烟雾病外科治疗的有效方式,但围手术期卒中发生率可达15.6%,且这部分患者预后不佳。该研究拟分析烟雾病围手术期卒中发生的危险因素,进而指导临床加强围手术期管理,以降低围手术期卒中发生率并改善患者预后。方法 纳入中南大学湘雅医院神经外科2011年1月—2021年4月手术治疗102例烟雾病患者的基本信息和影像学资料,采用多因素Logistic回归分析筛选该类患者围手术期卒中发生的危险因素。结果 102例烟雾病患者的平均发病年龄为28.22岁,共行118侧脑血运重建术,包括51次联合血运重建术和67次间接血运重建术。烟雾病围手术期卒中发生率为6.78%,其中缺血性卒中5例,出血性卒中3例,无死亡病例发生。多因素Logistic回归分析显示,高铃木分期(OR: 9.814;95%CI: 1.655~58.204, P=0.012)、低脑梗死评分(OR: 0.646;95%CI: 0.440~0.948, P=0.026)及脑白质高信号（WMHs）(OR: 7.302;95%CI: 1.203~44.310, P=0.031)是烟雾病围手术期卒中发生的危险因素。结论 具有高铃木分期、低脑梗死评分及WMHs特征的烟雾病患者围手术期卒中发生风险高,需对这些患者严格管理。     

围手术期急性脑梗死的炎症反应及相关危险因素

急性缺血性脑卒中是围手术期罕见但十分严重的并发症,能够引起严重的神经功能障碍,使术后病死率及致残率大大增加,严重影响患者术后恢复,给家庭及社会造成严重的负担.本综述对围手术期脑梗死的发病率及发病的高峰期、炎症因子在其发生发展中的作用和机制进行了概述,同时总结了围手术期急性脑梗死的危险因素,以期指导医生术前对患者进行脑梗...     

糖尿病行颅脑手术患者围术期发生心血管事件的影响因素研究

目的探讨糖尿病患者行颅脑手术围术期心血管事件的影响因素。方法分析2010-05-2013-12我院行颅脑手术的糖尿病患者197例,记录围手术期心血管事件的发生情况,并根据是否发生心血管事件分为心血管事件组和无心血管事件组,比较2组一般资料、手术时间、实验室检查结果等。结果糖尿病患者行颅脑手术围术期心血管事件发生率为21.8%(43/197),单因素分析结果显示年龄、尿微量白蛋白、糖化血红蛋白、空腹血糖、手术时间、心脏射血分数、合并冠心病、甘油三酯水平在2组间比较差异有统计学意义(P0.05)。多因素分析结果显示年龄≥60岁、合并冠心病、糖化血红蛋白≥7.5%、心脏射血分数50%、尿微量白蛋白≥30μg/mL、甘油三酯≥1.7mmo/L是糖尿病患者行颅脑手术围术期心血管事件的相关危险因素。结论年龄≥60岁、合并冠心病、糖化血红蛋白≥7.5%、心脏射血分数50%、尿微量白蛋白≥30μg/mL、甘油三酯≥1.7mmo/L是糖尿病患者行颅脑手术围术期心血管事件的主要危险因素。     

心理护理对心脏手术患者围术期的重要作用

目的探讨心理护理对心脏手术患者围术期的重要作用。方法对体外循环心内直视手术380例患者在围术期的心理异常表现及护理措施进行归纳总结。结果 380例患者无不良事件发生。结论心理护理对于心脏手术患者顺利度过围术期十分重要。     

老年人围术期神经系统并发症

外科手术围术期的神经系统并发症是患者预后差及死亡的重要原因，其发病风险与年龄 的增长存在密切的关系。随着老龄化的进展，老年患者手术的比例随之增加，围术期神经系统并发 症正逐渐引起人们的重视。本文主要总结围术期卒中、术后认知功能改变的机制和危险因素。并讨 论脑损伤的预防方法与脑保护策略，为临床实际应用提供理论依据。     

急性缺血性卒中血管内治疗围手术期抗凝治疗研究进展

目前急性缺血性卒中（acuteischemicstroke,AIS）患者在血管内治疗（endovascular treatment,EVT）围手术期进行抗凝治疗的安全性和有效性尚未明确。现有研究表明,在EVT术前使用抗凝药物并不会增加患者出血或不良预后的风险。而EVT术中抗凝虽然无法显著提高血管再通率,但对于改善患者的长期预后可能有积极作用。此外,EVT术后抗凝可以预防颅内动脉再闭塞的发生,并可能有改善脑部微循环的作用。因此,对于抗凝指征更加明确的、伴有心房颤动的AIS患者是否可以尽早开始抗凝值得进一步探索,今后仍需开展更多临床研究来评估AIS患者EVT围手术期抗凝治疗的安全性和有效性。     

神经外科围手术期深静脉血栓形成的防治进展

神经外科手术后深静脉血栓形成（deep veinthrombosis,DVT）,特别是肺动脉栓塞（pulmonaryembolism,PE）,是致患者死亡或预后不佳的主要因素之一。重视颅脑手术围手术期DVT,早发现、早治疗,可降低术后并发症发生率及死亡率。本文就围手术期凝血功能变化与术后DVT防治作简要综述。     

内镜经鼻蝶窦入路手术治疗急性卒中垂体腺瘤(附15例报告)

目的 探讨内镜经鼻蝶窦入路手术治疗急性卒中垂体腺瘤的手术技术和围手术期治疗方法.方法 回顾性分析2004年3月至2011年3月间治疗的急性卒中垂体腺瘤患者15例,男4例,女11例；平均年龄39.0岁,术前均行头CT、MRI及内分泌学检查,手术采用内镜经鼻蝶窦入路肿瘤切除术,围手术期给予补充肾上腺皮质激素.结果 本组患者中肿瘤全切12例,近全切除3例,无严重并发症及手术死亡.术后随访6 - 36个月,患者症状均明显好转,对垂体功能低下的患者给予激素替代治疗.结论 内镜经鼻蝶窦入路手术是治疗急性卒中垂体腺瘤安全、有效的方法,完善的围手术期处理措施是保证手术成功的关键.     

微血管减压术治疗三叉神经痛围手术期护理

目的总结微血管减压术治疗56例原发性三叉神经痛的围手术期观察和护理。方法分析重视危险因素,完善围手术期各阶段的处理措施,积极配合手术。结果 56例三叉神经痛患者手术均顺利,无严重并发症发生,效果良好。结论微血管减压术因其创伤小、效果好等优点,已广泛应用于三叉神经痛的临床治疗,重视围手术期的护理是保证良好临床疗效的关键。     

Thromboembolic complications in atrial fibrillation

I review the present understanding of thromboembolic complications and their prevention in patients with nonrheumatic atrial fibrillation. Chronic atrial fibrillation carries an annual 3-6% risk of thromboembolic complications, which is 5-7 times greater than that of controls with sinus rhythm. Paroxysmal atrial fibrillation is associated with a lower risk of thromboembolic complications than chronic atrial fibrillation. Heart failure and systemic hypertension seem to be significant clinical risk factors for stroke in patients with atrial fibrillation, but disagreement persists, and, with few exceptions, subgroups at particular risk have not been convincingly identified. The risk of stroke in persons with thyrotoxic atrial fibrillation seems to be lower than believed previously. Clinical studies have shown that left atrial dilatation is a consequence of the duration of atrial fibrillation rather than a cause, but the relation of left atrial enlargement to stroke is uncertain. Cerebral blood flow may be reduced during atrial fibrillation but seems to increase after cardioversion to sinus rhythm. A high prevalence of silent cerebral infarction has been detected in patients with chronic atrial fibrillation, but there seems to be a low risk of silent cerebral infarction in persons with paroxysmal atrial fibrillation. The one prospective study published to date on stroke prevention in patients with nonrheumatic chronic atrial fibrillation showed that anticoagulation with warfarin significantly reduced the incidence of thromboembolic complications.     

Stroke in thyrotoxicosis with atrial fibrillation

Chronic atrial fibrillation is associated with an increased risk of stroke. In elderly patients with thyrotoxicosis, atrial fibrillation is frequently encountered, and the true risk of cerebrovascular events in these patients is controversial. We retrospectively studied 610 patients with initially untreated thyrotoxicosis, 91 (14.9%) of whom had atrial fibrillation, with the highest frequency in the elderly patients. The risk of cerebrovascular events, with special attention to the first year after the diagnosis of thyrotoxicosis, was calculated using logistic regression methods with age, sex, and atrial fibrillation as independent variables. Only age was an important risk factor (p less than 0.005), whereas sex and atrial fibrillation were not significant (p = 0.09 and p = 0.17, respectively) as independent risk factors. This is contrary to other studies of patients with thyrotoxic atrial fibrillation, and the need for further clarification of this issue is clear. From our study the indication for prophylactic treatment with anticoagulants for prevention of stroke in thyrotoxic atrial fibrillation seems doubtful, especially as no controlled studies of such treatment in patients with atrial fibrillation are currently available.     

Mortality in acute stroke with atrial fibrillation. The Italian Acute Stroke Study Group

We compared 211 consecutive patients who had acute ischemic hemispheric stroke and atrial fibrillation with 837 consecutive patients who had stroke without atrial fibrillation. The atrial fibrillation group included a higher frequency of women, older subjects, and those with a severe neurologic deficit, abnormal computed tomogram, and elevated heart rate. The 1-month case-fatality rate in the atrial fibrillation group was 27% while that in the group without atrial fibrillation was 14%. The 6-month case-fatality rates in the two groups were 40% and 20%, respectively. The risk of death attributable to atrial fibrillation, adjusted for the effect of other prognostic factors, was significant at 1 month (relative risk = 1.55) and at 6 months (relative risk = 1.74). The causes of death were equally distributed in the two groups during both the acute and subacute phases. We conclude that atrial fibrillation is a negative prognostic factor in patients hospitalized for acute stroke. Nevertheless, cerebral embolism alone does not completely explain the increase in mortality for stroke patients with atrial fibrillation. Other associated pathogenetic mechanisms must also be taken into account.     

Coagulation factors and the increased risk of stroke in nonvalvular atrial fibrillation

We studied whether hemostatic abnormalities contribute to the increased risk of stroke in patients with nonvalvular atrial fibrillation. Hemostatic function was studied in four age-matched groups: 20 patients with nonvalvular atrial fibrillation and a previous ischemic stroke, 20 patients with nonvalvular atrial fibrillation without a previous stroke, 20 stroke patients with sinus rhythm, and 40 healthy controls. Both groups with nonvalvular atrial fibrillation had significantly higher concentrations of von Willebrand factor, factor VIII:C, fibrinogen, D-dimer (a fibrinolytic product), beta-thromboglobulin, and platelet factor 4; a significantly higher fibrinogen/antithrombin ratio; and significantly higher spontaneous amidolytic activity than the healthy controls. Prekallikrein levels were significantly lower in both groups with nonvalvular atrial fibrillation. Stroke patients with sinus rhythm had normal hemostatic function, normal concentrations of platelet-related factors, and a slightly increased concentration of fibrinopeptide A compared with the healthy controls. Both groups with nonvalvular atrial fibrillation differed from the stroke patients with sinus rhythm as they did from the healthy controls. No difference in hemostatic function was seen between the nonvalvular atrial fibrillation patients with and without a previous ischemic stroke. Thus, alterations in hemostatic function may contribute to the increased risk of stroke in patients with nonvalvular atrial fibrillation.     

Benefits and risks of oral anticoagulation for stroke prevention in nonvalvular atrial fibrillation

Nonvalvular atrial fibrillation is the most common clinically significant cardiac arrhythmia in the United States. It increases both the risk for and the severity of strokes and is associated with substantial morbidity, mortality, decreased quality of life, and related health care costs. Guidelines recommend anticoagulation therapy for the majority of patients with atrial fibrillation. Clinical trials have established that vitamin K antagonists are effective for stroke prevention for patients with atrial fibrillation for whom anticoagulation is recommended. However, vitamin K antagonists remain underutilized for a variety of reasons, including drug, physician, and patient factors. While vitamin K antagonists considerably reduce the risk of stroke, the absolute risk reduction varies according to individual patient risk factors. Accurately assessing each patient's true risk of stroke and bleeding is essential when determining which (if any) antithrombotic strategy should be used. Several stroke risk stratification schemes exist; of these, CHADS₂ is widely employed and simple. New, more sophisticated schemes may generate more precise risk estimates and better identify those patients for whom anticoagulant therapy offers a net clinical benefit. More studies are needed to determine the utility of bleeding risk stratification systems, as well as the role of surgical and interventional alternatives to anticoagulation treatment. Several novel oral anticoagulants are in (or have completed) phase 3 clinical trials. Dabigatran etexilate, approved in the United States in October 2010 for reducing the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation, now offers the first oral alternative to warfarin for patients with atrial fibrillation.     

Secondary prevention in non-valvular atrial fibrillation patients: a practical approach with edoxaban

Patients with atrial fibrillation and prior stroke or transient ischemic attack exhibit a very high risk of recurrence. Secondary prevention with oral anticoagulants is mandatory. Overall, clinical guidelines recommend the use of target-specific oral anticoagulants over vitamin K antagonists for secondary prevention of stroke in patients with atrial fibrillation. However, many patients with atrial fibrillation and previous stroke are not receiving the appropriate antithrombotic treatment, perhaps due to the perceived risks of anticoagulation including the risk of hemorrhagic transformation of an ischemic stroke. The ENGAGE AF-TIMI 48 trial showed that although edoxaban 60 mg and warfarin reduced the risk of stroke to a similar extent, edoxaban exhibited a lesser risk of bleeding, particularly intracranial hemorrhage. Importantly, these data were independent of the presence of prior stroke or transient ischemic attack. Therefore, edoxaban can be used in both primary and secondary prevention of stroke in patients with non-valvular atrial fibrillation. The aim of this review was to update the available evidence about edoxaban in the clinical management of secondary prevention in individuals with non-valvular atrial fibrillation.     

Use of ambulatory electrocardiography for the detection of paroxysmal atrial fibrillation in patients with stroke. Canadian Task Force on Preventive Health Care

BACKGROUND: Patients with stroke commonly undergo investigations to determine the underlying cause of stroke. These investigations often include ambulatory electrocardiography to detect paroxysmal atrial fibrillation. There is conflicting evidence in the literature regarding whether routine ambulatory electrocardiography should be performed in all or selected stroke patients. This paper reviews the available evidence on (1) the yield of ambulatory electrocardiography in detecting paroxysmal atrial fibrillation in patients with stroke or transient ischemic attack and (2) the effectiveness of anticoagulation in preventing recurrent stroke in patients with paroxysmal atrial fibrillation. METHODS: A MEDLINE search for primary articles was performed, and the references were reviewed manually. In addition, citations were obtained from experts. The evidence was systematically reviewed using the evidence-based methodology of the Canadian Task Force on Preventive Health Care. RESULTS: Ambulatory electrocardiography can detect atrial fibrillation not found on initial electrocardiogram in between 1% and 5% of people with stroke. Ambulatory electrocardiography is generally safe. The risk of recurrent stroke in the setting of paroxysmal atrial fibrillation is uncertain, but appears to be similar to that seen with chronic atrial fibrillation (about 12% per year). Therapy with warfarin may reduce this risk by about two-thirds as compared to placebo. The annual risk of major bleeding with warfarin therapy is between 1% and 3% but rates for individual patients depend on various specific risk factors. INTERPRETATION: There is insufficient evidence to recommend for or against the use of ambulatory electrocardiography for the detection of paroxysmal atrial fibrillation in either selected or unselected patients with stroke (C Recommendation). There is fair evidence to recommend therapy with warfarin for patients with stroke and paroxysmal atrial fibrillation (B Recommendation).     

Atrial fibrillation as an independent risk factor for stroke: the Framingham Study

The impact of nonrheumatic atrial fibrillation, hypertension, coronary heart disease, and cardiac failure on stroke incidence was examined in 5,070 participants in the Framingham Study after 34 years of follow-up. Compared with subjects free of these conditions, the age-adjusted incidence of stroke was more than doubled in the presence of coronary heart disease (p less than 0.001) and more than trebled in the presence of hypertension (p less than 0.001). There was a more than fourfold excess of stroke in subjects with cardiac failure (p less than 0.001) and a near fivefold excess when atrial fibrillation was present (p less than 0.001). In persons with coronary heart disease or cardiac failure, atrial fibrillation doubled the stroke risk in men and trebled the risk in women. With increasing age the effects of hypertension, coronary heart disease, and cardiac failure on the risk of stroke became progressively weaker (p less than 0.05). Advancing age, however, did not reduce the significant impact of atrial fibrillation. For persons aged 80-89 years, atrial fibrillation was the sole cardiovascular condition to exert an independent effect on stroke incidence (p less than 0.001). The attributable risk of stroke for all cardiovascular contributors decreased with age except for atrial fibrillation, for which the attributable risk increased significantly (p less than 0.01), rising from 1.5% for those aged 50-59 years to 23.5% for those aged 80-89 years. While these findings highlight the impact of each cardiovascular condition on the risk of stroke, the data suggest that the elderly are particularly vulnerable to stroke when atrial fibrillation is present.(ABSTRACT TRUNCATED AT 250 WORDS)     

Risk factors predisposing to stroke in an elderly Chinese population--a longitudinal study

A cohort of 427 (171 males, 256 females) elderly Chinese aged 60 years and over whose health status had been defined in a previous survey was reexamined after a 30-month period to determine the occurrence of stroke. Subjects who initially had a history of transient ischemic attacks (TIA) and nonrheumatic atrial fibrillation had a greater than 10-fold increased risk of stroke in the subsequent 30 months. Men, smokers, alcohol drinkers, overweight subjects, and diabetics, also had a relative risk greater than one, but this did not reach statistical significance. Hypertensive subjects did not have an increased risk of stroke. It is concluded that the most important risk factors in the elderly predisposing to stroke in the short-term are a history of TIA and atrial fibrillation. Preventive measures against these two conditions may have a greater short-term impact in the elderly in reducing stroke occurrence than modification of other risk factors. Further studies involving larger numbers are needed to confirm these findings.     

急性缺血性脑卒中CISS分型与危险因素相关性分析

目的探讨急性缺血性卒中中国缺血性卒中亚型（CISS）分型与不同危险因素的关系。方法回顾性分析连续登记的急性缺血性脑梗死患者,记录其危险因素,并按CISS分型标准将急性缺血性卒中分为5种类型并分析相关因素对其发生风险的影响。结果在纳入标准的212例急性缺血性卒中患者中,大动脉粥样硬化型99例（46.7%）、心源性卒中型35例（16.5%）、穿支动脉疾病45例（21.2%）、其他病因型5例（2.4%）、病因不确定型28例（13.2%）。吸烟者、高血压病、冠心病、心房颤动者在5亚型间比例差异具有统计学意义（P〈0.05）。相关和回归分析显示冠心病、心房颤动与心源性卒中亚型有正相关性（β=1.34、2.206,P〈0.05）,高血压病与穿支动脉疾病亚型有相关性,为正相关性（β=1.074,P〈0.05）。结论不同类型缺血性脑卒中与不同的危险因素有关,心房颤动、冠心病是心源性卒中亚型的危险因素,高血压病是穿支动脉疾病亚型的危险因素。