164例骨科住院患者神经内科术前评估会诊病例分析

目的通过分析综合性医院骨科住院患者神经内科术前评估会诊的临床资料，探讨神经内科术前评估会诊骨科患者的意义。方法统计2011年5月1日至2012年4月30日神经内科术前评估会诊的骨科住院患者的临床资料。对申请会诊的骨科住院患者的一般情况、疾病诊断以及术前评估会诊内容、预后等进行统计分析。结果术前评估会诊患者共164例，男78例，女86例，年龄24～89（60．2±12.3）岁。脊柱骨科（37.8％，62／164）、创伤骨科（31．1％，51／164）及矫形骨科（23．2％，38／164）申请会诊数量最多。术前评估会诊种类：脑梗死101例（61．6％，101／164）最常见，其次为脑出血后遗症15例（9．1％，15／164）及帕金森病14例（8．5％，14／164）等。神经内科术前评估会诊意见包括：（1）指导患者围手术期用药，包括脑血管病、帕金森病、癫痫及其他神经系统疾病。（2）评估骨科术后脑梗死的风险，评价脑血管狭窄程度及侧支循环。（3）会诊需要检查的内容以经颅多普勒52．4％（86／164）]、颈部血管超声44．5％（73，164）]及头颅CT37．8％（62／164）]最常见。（4）共取消手术8例。经术前会诊的患者仅有3例（2例老年痴呆患者，1例帕金森病患者）术后出现神经系统并发症。结论神经内科术前评估会诊骨科患者有利于降低其脑卒中风险，改善患者临床预后，避免出现神经系统并发症。

Retrospective analysis of 164 preoperative neurology consultation cases in orthopedics inpatients

Objective To investigate the evaluation of preoperative neurology consultation in orthopedics inpatients through analysis of the clinical data in general hospital. Methods Preoperative neurology consultation for orthopedics inpatients including general condition, diagnosis,preoperative assessment consultation content and prognosis from May 1,2011 to April 30,2012 were analyzed retrospectively. Results A total of 164 patients were enrolled,with 86 female and 78 male, the age was 24-89 （60.2 ± 12.3 ） years. The main consultation departments were spinal department （37.8% ,62/164）, trauma department （31.1% ,51/164） and orthopedic department （23.2% ,38/164）. The main preoperative diseases were cerebral ischemia （61.6% ,101/164）, old intracranial hemorrhage （9.1% ,15/164） and Parkinson disease（ 8.5%, 14/164）. The neurology preoperative consultations including： （ 1 ）Directing the drug administration in the perinperative period, including vascular disease, Parkinson disease, epilepsy and other neurological disease. （2）Evaluating the cerebral ischemia risk of the orthopedics operation, cerebral vascular stenosis and collateral circulation. （3） The main complementary tests were transcranial doppler 52.4% （86/164） ], extracranial sonography 44.5%（73/164） ] and computer tomography 37.8%（62/164） ]. （4） Altogether 8 operations had been cancelled. Three patients （2 cases of Alzheimer disease, 1 case ofParkinson disease） experienced postoperative neurologic complications. Conclusion Neurology preoperative evaluation consultation in orthopedic patients is helpful to reduce their risk of stroke, improve the prognosis of patients, and avoid neurological complications.