全膝关节置换术围手术期脑梗死危险因素及预后分析  

Risk factors and prognosis of perioperative ischemia stroke in total knee arthroplasty

作　　者：闫欣[1] 王曼 高阳 闫立荣[1] 高倩[1] 姜明[1] 马志刚[1] YAN Xin;WANG Man;GAO Yang;YAN Lirong;GAO Qian;JIANG Ming;MA Zhigang(Department of Neurology,Beijing Jishuitan Hospital,Beijing 100096,China;不详)

机构地区：[1]北京积水潭医院神经内科,北京100096 [2]北京积水潭医院信息中心,北京100096 [3]北京积水潭医院病案室,北京100096

出　　处：《实用医学杂志》2020年第21期2942-2946,共5页The Journal of Practical Medicine

基　　金：北京积水潭医院学科新星基金项目(编号:XKXX201611)。

摘　　要：目的探讨全膝关节置换术围手术期脑梗死的发病率、危险因素以及预后,以指导围手术期风险管理。方法选取我院2008-2018年行全膝关节置换术的患者,记录患者的人口学资料、日常生活能力评分、术前合并症、手术类型、麻醉方式、是否进入重症监护室、输入红细胞、血小板以及血浆的数量。使用χ^2检验和t检验分析患者预后,使用logistic回归模型分析全膝关节置换术围手术期急性梗死的危险因素。结果共16490例患者行全膝关节置换手术,男性3453例,年龄18~90岁,平均年龄64.24岁。11例患者出现全膝关节置换手术后脑梗死,男性3例,女性8例,年龄55~80岁,平均年龄68.82岁,围手术期脑梗死的发病率为0.07%。术后脑梗死发生的时间1~3 d,中位数为1 d。围手术期脑梗死患者出院时日常生活能力显著下降(40.50 vs.56.35,P<0.001),进入监护室比例明显增加(1.10%vs.27.30%,P<0.001)。单因素分析显示,高血压、糖尿病、心房纤颤、高脂血症、脑梗死病史、贫血以及双侧手术方式是围手术期脑梗死的危险因素(P<0.05)。多因素logistic回归分析显示,脑梗死病史(OR=88.586,95%CI:22.076~355.561,P<0.001)、心房纤颤(OR=18.230,95%CI:1.637~203.026,P=0.018)和双侧手术方式(OR=7.226,95%CI:1.985~26.304,P=0.003)是全膝关节置换术围手术期脑梗死的危险因素。结论全膝关节置换术围手术期脑梗死患者预后差,对具有脑梗死病史、心房纤颤及双侧膝关节置换术等危险因素的患者进行识别预警,以减少围手术期脑梗死的发生。Objective The aim of the study was to investigate the incidence,risk factors and prognosis of perioperative stroke of total knee arthroplasty(TKA),which could identify a strategy to minimize the prevalence of the complication.Methods We performed an observational study of patients undergoing TKA from 2008 to 2018 in our hospital.The patients′demography,risk factors,operational conditions and anesthesia method,transferring to ICU and infusion amount of RBC,PLT or plasma were recorded.χ^2 and t-test were used to analyze the prognosis,and logistic regression were used to analyze the predictable risk factors.Results Totally,16490 patients underwent TKA,with 3453 male patients,mean age 62.24 year-old(range:18~90 years).11 patients had perioperative acute ischemia stroke,including three men and eight women,with a mean age of 68.82 years(range:55~80 years),and the institutional perioperative stroke rate was 0.07%.The median time of perioperative stroke was 1 day(range:1~3 days).Perioperative stroke patients had significantly lower activity of daily living score(40.50 vs.56.35,P<0.001)and higher percent of transferring to ICU(1.10%vs.27.30%,P<0.001)compared with TKA patients.Univariate analysis demonstrated that hypertension,diabetes,atrial fibrillation,hyperlipidemia,ischemia stroke history,anemia and bilateral TKA were risk factors of perioperative stroke in TKA(P<0.05).Multivariate logistical analysis demonstrated that ischemia stroke history(OR=88.586,95%CI:22.076~355.561,P<0.001),atrial fibrillation(OR=18.230,95%CI:1.637~203.026,P=0.018)and bilateral TKA(OR=7.226,95%CI:1.985~26.304,P=0.003)were independent risk factors of perioperative stroke in TKA.Conclusion Perioperative stroke in TKA had poor prognosis.High-risk patients with previous stroke,atrial fibrillation,or bilateral TKA should be recognized and alert in clinical practice,in order to decrease occurrence of perioperative stroke in TKA.

关 键 词：全膝关节置换术 围手术期 脑梗死 危险因素 

分 类 号：R741[医药卫生—神经病学与精神病学]