关键词: 全膝关节置换术, 围手术期, 脑梗死, 危险因素

Abstract:

Objective The aim of the study was to investigate the incidence，risk factors and prognosis ofperioperative stroke of total knee arthroplasty（TKA），which could identify a strategy to minimize the prevalence ofthe complication. Methods We performed an observational study of patients undergoing TKA from 2008 to 2018in our hospital. The patients′ demography，risk factors，operational conditions and anesthesia method，transferringto ICU and infusion amount of RBC，PLT or plasma were recorded. χ2 and t⁃test were used to analyze the prognosis，and logistic regression were used to analyze the predictable risk factors. Results Totally，16 490 patients under⁃went TKA，with 3 453 male patients，mean age 62.24 year⁃old（range：18 ~ 90 years）. 11 patients had perioperativeacute ischemia stroke，including three men and eight women，with a mean age of 68.82 years（range：55 ~ 80years），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 TKApatients. Univariate analysis demonstrated that hypertension，diabetes，atrial fibrillation，hyperlipidemia，isch⁃emia stroke history，anemia and bilateral TKA were risk factors of perioperative stroke in TKA（P < 0.05）. Multi⁃variate 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 bilateralTKA should be recognized and alert in clinical practice，in order to decrease occurrence of perioperative stroke in TKA.

Key words: total knee arthroplasty, postoperative care, ischemia stroke, risk factor