背景:本研究旨在评估术后卒中与术中血流动力学变异性和输血管理的相关性。
方法:在本病例对照研究中,在手术后72小时内发生中风的成年患者(≥18岁)根据年龄与2名对照患者相匹配,性别,和程序类型。评估的主要危险因素是术中液体给药,血液制品输血,血管加压药的使用,以及收缩压和舒张压和心率变异性的测量:最大值,minimum,范围,SD,和平均实际可变性。变量用条件逻辑回归分析,占1:2匹配的病例对照研究设计。
结果:在687.581程序中,我们确定了64例术后中风(发病率,每100.000次手术9.3[95%CI,7.2-11.9]次中风)。这些病例与128个对照相匹配。中风病例的Charlson发病指数得分高于对照组(P=0.046)。血压和心率变异性测量与中风无关。输注红细胞(RBC)后卒中风险增加(比值比[OR],14.82;95%CI,3.40-64.66;P<.001),使用血管加压药(或,3.91;95%CI,1.59-9.60;P=.003),和更长的手术持续时间(或,1.23/h;95%CI,1.01-1.51;P=.04)。程序持续时间的多变量分析,红细胞输血,和血管加压药的使用表明,只有红细胞输血与卒中风险增加独立相关(OR,10.10;95%CI,2.14-47.72;P=.004)。
结论:血压变异性与术后卒中风险增加无关;然而,红细胞输注是独立危险因素。
BACKGROUND: This study aims to assess the association of postoperative stroke with intraoperative hemodynamic variability and transfusion management.
METHODS: In this
case-control study, adult patients (≥ 18 years) who had a stroke within 72 hours of a surgical procedure were matched to 2 control patients according to age, sex, and procedure type. Primary risk factors assessed were intraoperative fluid administration, blood product transfusion, vasopressor use, and measures of variability in systolic and diastolic blood pressure and heart rate: maximum, minimum, range, SD, and average real variability. The variables were analyzed with conditional logistic regression, which accounted for the 1:2 matched
case-control study design.
RESULTS: Among 687 581 procedures, we identified 64 postoperative strokes (incidence, 9.3 [95% CI, 7.2-11.9] strokes per 100 000 procedures). These cases were matched with 128 controls. Stroke cases had higher Charlson cmorbidity index scores than did controls (P = .046). Blood pressure and heart rate variability measures were not associated with stroke. The risk of stroke was increased with red blood cell (RBC) transfusion (odds ratio [OR], 14.82; 95% CI, 3.40-64.66; P < .001), vasopressor use (OR, 3.91; 95% CI, 1.59-9.60; P = .003), and longer procedure duration (OR, 1.23/h; 95% CI, 1.01-1.51; P = .04). Multivariable analysis of procedure duration, RBC transfusion, and vasopressor use showed that only RBC transfusion was independently associated with an increased risk of stroke (OR, 10.10; 95% CI, 2.14-47.72; P = .004).
CONCLUSIONS: Blood pressure variability was not associated with an increased risk of postoperative stroke; however, RBC transfusion was an independent risk factor.