有麻醉科参与的卒中单元有效救治围手术期脑卒中1例

围手术期脑梗塞指围手术期发生的缺血性脑卒中，在非心脏、非脑科手术中，其发生率大约为 0.7%，但其一旦发生，病死率却高达26%~40%［1-2］，严重影响手术患者的生活质量和预后。2015年5月，北京大学第三医院一位患者在全身麻醉下行腰椎后路减压内固定手术，术毕全身麻醉清醒后2 h之内发生了脑梗塞，经麻醉医师早期发现、多科室协作的围手术期卒中单元迅速启动，患者预后良好，现报道如下。

Perioperative stroke effectively treated by an acute stroke team including anesthesia department: a case report

Perioperative stroke is cerebral infarction occurring in the perioperative period.The incidence of perioperative stroke in non-cardiac,and non-neurologic surgery is about 0.7％,but the mortality can be as high as 26％ to 40％.The outcome of the patients with perioperative stroke can be disastrous.Here we report a case of perioperative ischemic stroke that occurred after surgery of lumbar decompression and pedical screw fixation.A 76-year-old female admitted to our hospital because of lumbar spinal stenosis.Her medical history included hypertension and diabetes for ten years.Her personal history included a smoking history of 60 years by 2 cigarettes per day,not quitting.Her carotid artery ultrasound showed multiple low echo plaques on the right side and multiple high echo plaques on the left side of the carotid artery,but without distinct stenosis.Other examinations and tests showed no distinct abnormality.She went on a lumbar decompression and pedical screw fixation uneventfully.The blood loss was 400 mL and autologous blood transfusion 150 mL.The arterial blood pressure (ABP) maintained during 100-130 mmHg/60-80 mmHg (1 mmHg =0.133 kPa).Sixty minutes after she recovered from general anesthesia,the patient developed symptoms of slurred speech and right limbs weakness.The anesthesiologist evaluated the patient immediately with National Institute of Health Stroke Scale (NIHSS).The NIHSS score was 11 and a stroke was highly suspected.The acute stroke team was therefore initiated and fast responded.Within 4 h,digital subtraction angiography (DSA) was proceeded,which showed the M1 segment of the left middle cerebral artery was occluded and the local stenosis of her right middle cerebral artery was up to 80％.After the successful embolectomy by Solitaire stent,the left middle cerebral artery reflowed and the forward blood flow was thrombolysis in myocardial infarction (TIMI) grade 3.The patient was discharged after 33 days after the surgery with a NIHSS of 9.Our case provides an example that an acute stroke team that included the department of anesthesiology can be beneficial to the patients' perioperative strokes.During the perioperative period,anesthesiologists should be included into the acute stroke team,because anesthesiologists and anesthesia nurses might be first observers of those early onset strokes.Our case also put forward this thought that a standard peri-operative stroke evaluation tool,like NIHSS,should be discussed and applied to facilitate and accelerate the initiation of perioperative acute stroke team.