非心脏术后脑梗死病因的影像学分析

Radiological imaging in evaluation of etiologies for cerebral infarction after non-cardiac surgeries

目的根据影像学探讨非心脏术后脑梗死的病因。方法回顾性分析骨科和普通外科术后17例脑梗死患者临床和影像资料。结果脑梗死平均发生于术后39．1h。意识障碍8例，偏身无力10例，言语异常6例，偏身感觉障碍2例。6例化验血脂，5例行颈部血管超声检查，1例行头磁共振血管成像（MRA）检查。出院时1例死亡，10例遗留不同程度神经系统体征；仅有1例既往脑梗死患者术前请神经内科会诊。将脑梗死影像分为流域性（10例）、半卵圆区（4例）和分水岭区（3例）。结论非心脏术后脑梗死总发生率低于报道，动脉粥样硬化更多参与发病。术后至少4d内要密切观察病情。应加强术前评估避免脑梗死的发生。

Objective To investigate the pathogenesis of cerebral infarction after non-cardiac surgeries according to imaging. Methods Retrospective analyses of clinical and imaging data of 17 patients with postoperative cerebral infarction （average 68 years old, total incidence 0. 049% ） from departments of orthopedics and general surgery were conducted during 52 months. Results Cerebral infarction occurred 39.1 hours after operation on average. Among the 17 patients, eight were detected with disturbance of consciousness, ten with hemiplegia, six with speech disorder and two with unilateral sensory disturbance. Six （35.3%） had blood lipids tests. Five （29.4%） had neck vascular ultrasound and one had intracranial magnetic resonance angiography （MRA）. When discharged, one patient was declared death and ten had impaired neurological function in various degrees. Among six patients with previous stroke, one （16. 7% ） received neurological consultation before surgery. According to the image manifestation, ten cases were territory circulation infarcts, four centrum ovale infarcts and three watershed infarcts. Conclusions This study suggests that total incidence of cerebral infarction after non-cardiac surgeries is lower than previously reported and there is greater involvement of atherosclerosis. Patients＇ conditions should be closely observed within at least four days after surgeries. Preoperative assessment should be strengthened in order to avoid occurrence of postoperative cerebral infarction.