Perioperative Cerebral Infarction In Noncardiac And Nonvascular Surgery

Objective: To evaluate the relative risk factors and mechanisms of perioperative cerebral infarction in noncardiac and nonvascular surgery, to further improve prevention and treatment of perioperative cerebral infarction.Methods: Patients occurred new neurological deficits such as hemiplegia,paresthesia,dysarthria or conscious disturbance in or 14 days after noncardiac and nonvascular surgery at the First Affiliated Hospital of Guangxi Medical University between June 2005 and December were subjected to analysis. Data of sex, age, Previous history, procedures,operation time, intraoperative blood pressure,clinical symptoms and cranial CT examination results were recorded.Results: A total of 22 patients occurred cerebral infarction in the perioperative period.There were 11 males and 11 females. Perioperative cerebral infarction risk factors include: preexisting risk factors: 17 patients have one or more stroke risk factors such as preoperative hypertension, diabetes, previous stroke or myocardial infarction. Surgery-related factors: Brain surgery in 7 cases, abdominal surgery in 8 cases, orthopedic surgery in 4 cases, chest surgery in 3 cases. Anesthesia in 13 cases (59.1%), epidural anesthesia in 8 patients (36.4%), brachial plexus block in 1 patients (4.5%). Peripheral leukocyte count rise after surgery (postoperative: 13.31±4.33×109/L vs preoperative: 8.54±2.71×109/L, P < 0.05). Cerebral infarction occurred in or within 24 hours after surgery in 6 patients,1 to 3 days after surgery in 9 patients,4 to 7 days after surgery in 3 patients,8 to 10 days after surgery in 3 patients, and 12 days after surgery in 1 patient. All patients manifested as limb or one-sided numbness, weakness, speech and swallowing difficulties or other manifestations of focal neurological deficits. Discharged without disability in 7 patients(31.8%), 4 patients of mild to moderate disability(18.2%),severe disability in 9 patients(40.9%), 2 patients died(9.1%).Conclusions: Preexisting stroke risk factors and Surgery-related factors including intraoperative hypotension, type of surgery and anaesthesia, stress may play an important role in perioperative cerebral infarction in noncardiac and nonvascular surgery.Perioperative cerebral infarction in noncardiac and nonvascular surgery still lack effective treatment and have poor prognosis.