骨折手术围手术期脑卒中发生的相关危险因素研究

Analysis of the related factors of stroke during perioperative period of fracture surgery

目的分析骨折手术围手术期发生脑卒中的相关危险因素。方法回顾性收集2013年1月—2021年3月在首都医科大学附属大兴区人民医院行骨折手术并发生术中或术后脑卒中的患者,设为卒中组;根据性别、骨折部位按照1∶1比例匹配行骨折手术未发生脑卒中的患者,设为对照组。通过住院病历系统采集资料,包括个人基本情况、合并慢性疾病情况、骨折类型、手术时间、麻醉方式等相关信息。主要结局指标为是否发生围手术期脑卒中。经Logistic回归分析骨折患者围手术期发生脑卒中的相关危险因素。结果本研究最终纳入140例患者,其中卒中组70例、对照组70例,骨折患者围手术期脑卒中的发生率为1.05%。与对照组比较,卒中组患者年龄、BMI较高,手术时间较长,ASA分级Ⅱ/Ⅲ级比例较低,高血压、心房颤动、高脂血症、既往脑部疾病比例均较高(P<0.05)。骨折患者围手术期发生脑卒中的独立危险因素为年龄、BMI、高血压、高脂血症、心房颤动、既往脑部疾病、手术时间(P<0.05);调整ASA分级、性别、骨折部位混杂因素后的危险因素为高血压、高脂血症、心房颤动、既往脑部疾病、手术时间(P<0.05)。全身麻醉方式下独立危险因素为年龄和高血压(P<0.05),调整ASA分级、性别、骨折部位混杂因素后危险因素为高血压(P<0.05)。腰硬联合麻醉方式下独立危险因素为年龄、BMI、高血压、既往脑部疾病、手术时间(P<0.05),调整ASA分级、性别、骨折部位混杂因素后危险因素是年龄、既往脑部疾病和手术时间(P<0.05)。结论高血压、高脂血症、心房颤动、既往脑部疾病和手术时间是骨折患者围手术期发生脑卒中的高危因素。在全身麻醉状态下,高血压是患者围手术期发生脑卒中的高危因素;在腰硬联合麻醉状态下,年龄、既往脑部疾病、手术时间是围手术期发生脑卒中的高危因素。

Objective To investigate the related factors of stroke during perioperative period undergoing fracture surgery.Methods Patients undergoing fracture surgery and suffering intraoperative or postoperative stroke from January 2013 to March 2021 in Beijing Daxing District People's Hospital,Capital Medical University were selected and set as stroke group.At the same time,those patients undergoing fracture surgery were selected in which sex and fracture site were matched at a ratio of 1∶1 and set as a control group.Data were collected through medical record system including basic information of patients,complications of chronic disease,type of fracture,operation time,type of anesthesia etc.The main outcome index was occurrence of perioperative stroke,thus Logistic regression analysis was used to analyze the risk factors of stroke in fracture patients during perioperative period.Results In this study,140 patients were included,containing 70 patients in the stroke group and 70 patients in the control group and the incidence of stroke of perioperative operative period was 1.05%.The age and body mass index(BMI)in the stroke group were higher than those in the control group,and the operation time was longer than that in the control group,the proportion of American Society of Anesthesiologists(ASA)Ⅱ/Ⅲin the stroke group was lower than that in the control group,and hypertension,atrial fibrillation and hyperlipidemia,the proportion of previous brain diseases was significantly higher than that in the control group(P<0.05).Age,BMI,hypertension,hyperlipidemia,atrial fibrillation,brain disease and operation time were independent risk factors for stroke in patients with fracture during perioperative period(P<0.05).The multiple regression analysis showed that independent risk factors including hypertension,hyperlipidemia,atrial fibrillation,brain disease and operation time after adjusting for confounding factors including ASA grade,gender and fracture site(P<0.05).Independent risk factors under general anesthesia were age and hypertension(P<0.05);hypertension was risk factors for stroke after adjusting confounding factors including ASA grade,gender and fracture site(P<0.05).Meanwhile,independent risk factors under combined spinal epidural with anesthesia included age,BMI,hypertension,brain disease,operation time(P<0.05).Age,brain disease and operation time were risk factors after adjusting for confounding factors containing ASA grade,gender and fracture site(P<0.05).Conclusions Hypertension,hyperlipidemia,atrial fibrillation,brain disease and operation time are the high-risk factors of stroke in fracture patients during perioperative period.Under general anesthesia,hypertension is the high-risk factor of stroke during perioperative period.Under spinal epidural anesthesia,age,brain disease and operation time are the high-risk factors of stroke during perioperative period.