由加拿大西安大略大学等机构组成的研究团队，对非心脏手术患者围手术期隐性卒中进行了一项前瞻性队列研究。相关论文于2019年8月15日在线发表于《柳叶刀》。

这项前瞻性队列研究在9个国家的12个学术中心进行，参与者年龄均在65岁及以上，住院后择期行非心脏手术，术后进行脑MRI检查。由两名独立的神经放射学专家对MRI急性脑梗死进行评估，他们对患者的临床数据并不知情。研究组采用多变量回归探讨了隐性卒中与认知功能下降之间的关系，认知下降定义为随访一年后蒙特利尔认知评估较术前下降2分及以上。患者、医护人员和评审人员均对MRI结果不知情。

2014年3月24日至2017年7月21日，1114例参与者中有78例发生围手术期隐性卒中。随访1年后，69例围手术期隐性卒中患者中有29例（42%）发生认知功能下降；932例无围手术期隐性卒中患者中有274例（29%）发生认知功能下降。隐性卒中增加了围手术期谵妄、显性卒中和短暂性脑缺血发作的风险。

围手术期隐性卒中与非心脏手术1年后认知功能下降的风险正相关，对于65岁及以上非心脏手术的患者，每14例中就有1例发生围手术期隐性卒中。而围手术期隐性卒中的防治策略仍有待研究。

据了解，在非心脏手术中，隐性卒中比显性卒中更常见，并与认知能力下降有关。非心脏手术后成人发生显性卒中率不到1%，但研究组对围手术期隐性卒中知之甚少。因此，他们主要研究了围手术期隐性卒中（即无卒中症状的患者非心脏手术后MRI检测到急性脑梗死）与术后1年认知功能下降之间的关系。

附：英文原文

Title: Perioperative covert stroke in patients undergoing non-cardiac surgery (NeuroVISION): a prospective cohort study

Author: The NeuroVISION Investigators

Issue&Volume: Volume 394 Number 10198, 17 August 2019

Summary: 

Background

In non-surgical settings, covert stroke is more common than overt stroke and is associated with cognitive decline. Although overt stroke occurs in less than 1% of adults after non-cardiac surgery and is associated with substantial morbidity, we know little about perioperative covert stroke. Therefore, our primary aim was to investigate the relationship between perioperative covert stroke (ie, an acute brain infarct detected on an MRI after non-cardiac surgery in a patient with no clinical stroke symptoms) and cognitive decline 1 year after surgery.

Methods

NeuroVISION was a prospective cohort study done in 12 academic centres in nine countries, in which we assessed patients aged 65 years or older who underwent inpatient, elective, non-cardiac surgery and had brain MRI after surgery. Two independent neuroradiology experts, masked to clinical data, assessed each MRI for acute brain infarction. Using multivariable regression, we explored the association between covert stroke and the primary outcome of cognitive decline, defined as a decrease of 2 points or more on the Montreal Cognitive Assessment from preoperative baseline to 1-year follow-up. Patients, health-care providers, and outcome adjudicators were masked to MRI results.

Findings

Between March 24, 2014, and July 21, 2017, of 1114 participants recruited to the study, 78 (7%; 95% CI 6–9) had a perioperative covert stroke. Among the patients who completed the 1-year follow-up, cognitive decline 1 year after surgery occurred in 29 (42%) of 69 participants who had a perioperative covert stroke and in 274 (29%) of 932 participants who did not have a perioperative covert stroke (adjusted odds ratio 1·98, 95% CI 1·22–3·20, absolute risk increase 13%; p=0·0055). Covert stroke was also associated with an increased risk of perioperative delirium (hazard ratio [HR] 2·24, 95% CI 1·06–4·73, absolute risk increase 6%; p=0·030) and overt stroke or transient ischaemic attack at 1-year follow-up (HR 4·13, 1·14–14·99, absolute risk increase 3%; p=0·019).

Interpretation

Perioperative covert stroke is associated with an increased risk of cognitive decline 1 year after non-cardiac surgery, and perioperative covert stroke occurred in one in 14 patients aged 65 years and older undergoing non-cardiac surgery. Research is needed to establish prevention and management strategies for perioperative covert stroke.

DOI: https://doi.org/10.1016/S0140-6736(19)31795-7

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31795-7/fulltext#