普外科手术后期并发脑梗死患者的相关危险因素病例对照研究

目的:探讨普外科手术后期患者并发脑梗死与其相关危险因素的关系,以指导普外科医生在术前和术中有效评估病人发生手术后期脑梗死的风险,并做到积极预防。方法:回顾性分析我院2009年~2014年普外科手术后期发生脑梗死的患者,采用病例对照研究的方法,将手术后发生脑梗死的患者36例作为病例组,按手术方式进行1:2配比,从相同手术方式且未发生脑梗死的的患者中随机抽取72例作为对照,采用SPSS13.0软件进行单因素和多因素条件Logistic回归分析。结果:单、多因素条件Logistic回归分析表明,高血压、糖尿病、血脂异常,术中低灌注均可能是普外科手术后期发生脑梗死的危险因素,多因素Logistic回归分析显示,在调整年龄和性别后,术中低灌注仍最容易发生脑梗死,其次为糖尿病和高血压病史。结论:普外科术中应注意血压的监测和控制,尽量避免或减少低灌注;术前良好控制血压、血脂、血糖有助于降低普外科手术后患者发生脑梗死的风险;普外科医生应根据手术患者危险因素的多少及严重程度,尤其对于高龄患者,选择合理的手术时机及手术方式可能归避手术后期脑梗死的发生。

Case-control Study on Risk Factors of Cerebral Infarction in Postoperative Period after General Surgery Operations

Objective:To investigate the risk factors of cerebral infarction after general surgery and to supply a better assessment and effective prevention of cerebral infarction after general surgery.Methods:Data of patients undergoing general surgery with cerebral infarction in the Fourth Affiliated Hospital of Harbin Medical University from 2009 to 2014 were retrospectively analyzed. 72 patients who were randomly selected without infarction in the control group compared with 36 patients with cerebral infarction after surgery conducted in the patient group by 1:2 Ratio in the same surgical procedure. The influence of risk factors for cerebral infarction after surgery was analyzed with the simple Logistic regression analysis, the multiple Logistic regression analysis. All the statistical analysis was performed by SPSS13.0.Results:The simple and themultiple Logistic stepwise regression analysis showed that hypertension, diabetes, dyslipidemia, and intraoperative hypoperfusion were likely to be risk factors of cerebral infarction after surgery. The multiple Logistic stepwise regression analysis showed that, after adjustment for age and gender, intraoperative was still the most prone to cerebral infarction, followed by the history of hypertension and diabetes.Conclusion:Measuring and monitoring the blood pressure and avioding the hypoperfusion are conducive to reduce the incidence of cerebral infarction in surgery. The control of blood pressure, blood-fat and blood glucose actively before surgery in patients can help to reduce the risk of cerebral infarction after surgery. The occurrence of cerebral infarction after surgery may be avoided by a reasonable choice of surgical timing and operative procedure according to the number and the severity of risk factors in surgical patients, especially for elderly ones.