摘要
目的:探讨以局部麻醉作为首要麻醉的麻醉模式在急性前循环缺血性脑血管病机械取栓术中的有效性及安全性。方法:回顾性分析自2017年1月至2021年4月首都医科大学大兴教学医院连续入组登记的124例急性前循环缺血性脑血管病机械取栓患者的临床及取栓手术数据，采用局部麻醉模式作为首要麻醉方式进行取栓手术，术中根据患者的情况决定是否需要转化为全身麻醉，最终根据麻醉方式分为局部麻醉组（100例）与转化全身麻醉组（24例）。收集患者的临床资料，采用单因素分析比较2组患者的临床结局及颅内出血不良事件等的差异，采用多因素Logistic回归分析局部麻醉转化为全身麻醉的预测因素。结果:局部麻醉组患者90 d时良好预后率高于转化全身麻醉组[61.0%（61/100）vs12.5%（3/24）]，死亡率低于转化全身麻醉组[9.0%（9/100）vs37.5%（9/24）]，差异具有统计学意义（χ2=18.230、12.669，P均＜0.001）。在安全性方面，2组患者颅内出血及症状性颅内出血比例分别为9.0%（9/100）、16.7%（4/24）及3.0%（3/100）、8.3%（2/24)），差异无统计学意义（P＞0.05）。单因素分析结果显示，局部麻醉组与转化全身麻醉组患者基线国立卫生研究院卒中量表（NIHSS）评分[13（10，16）分 vs 16（13，19）分]和取栓次数[1（1，2）次 vs2（1，3）次]比较，差异具有统计学意义（Z=2.860、2.475，P=0.004、0.013）。多因素Logistic回归分析显示，术前基线NIHSS评分（OR=1.241，95%CI：1.020~1.238，P=0.018）、取栓次数（OR=1.543，95%CI：1.028~2.316，P=0.036）是急性前循环缺血性脑血管病机械取栓患者转化为全身麻醉的预测因素。结论:以局部麻醉为首要麻醉的麻醉模式在急性前循环大动脉闭塞血管内取栓治疗中可能是安全、有效的，局部麻醉转化为全身麻醉的比例较低，这可能与术前脑卒中患者的严重程度及取栓次数有关。
Abstract
Objective:To explore the effectiveness and safety of local anesthesia as the primary anesthesia mode in mechanical thrombectomy for acute anterior circulation ischemic cerebrovascular disease.Methods:A retrospective analysis was performed on the clinical and surgical data of 124 consecutive enrolled patients with acute anterior circulation ischemic stroke who underwent mechanical thrombectomy from January 2017 to April 2021 at Daxing Teaching Hospital of Capital Medical University. Local anesthesia mode was used as the primary anesthesia method for thrombectomy, and the need to convert to general anesthesia was determined based on the patient's condition during the surgery. Finally, according to the anesthesia method, they were divided into the local anesthesia group (100 cases) and the conversion to general anesthesia group (24 cases). Clinical data of patients were collected. Univariate analysis was used to determine the clinical outcomes and adverse events of cerebral hemorrhage in the two groups, while multivariate logistic regression analysis was used to determine the predictive factors for local anesthesia group patients converting to general anesthesia.Results:The good prognosis rate of patients in the local anesthesia group at 90 days was higher than that in the conversion to general anesthesia group [61.0% (61/100) vs 12.5% (3/24)], and the mortality rate was lower than that in the conversion to general anesthesia group [9.0% (9/100) vs 37.5% (9/24)], with statistically significant differences（χ2=18.230, 12.669, both P＜0.001). In terms of safety, the proportions of patients with intracranial hemorrhage and symptomatic intracranial hemorrhage between the two groups were 9.0% (9/100), 16.7% (4/24), 3.0% (3/100) and 8.3% (2/24), respectively. There was no significant difference between the two groups (P＞0.05). The results of univariate analysis showed that there was a statistically significant difference in baseline National Institutes of Health Stroke Scale (NIHSS) scores [13(10, 16) vs 16(13, 19)] and thrombectomy frequency [1 (1,2) vs 2(1, 3)] between the local anesthesia group and the conversion to general anesthesia group (Z=2.860, 2.475; P=0.004, 0.013). Multivariate logistic regression analysis showed that preoperative baseline NIHSS score (OR=1.241, 95%CI: 1.020-1.238, P=0.018) and thrombectomy frequency (OR=1.543, 95%CI: 1.028-2.316, P=0.036) were predictive factors for conversion to general anesthesia in patients with acute anterior circulation ischemic stroke undergoing mechanical thrombectomy.Conclusion:It may be safe and effective to use local anesthesia as the primary anesthesia mode of acute anterior circulation artery occlusion with thrombectomy. The proportion of patients with local anesthesia converted to general anesthesia is relatively low, which is related to the severity of preoperative stroke patients and the thrombectomy frequency.
基金项目
首都医科大学大兴区人民医院科研课题(4202133396)
万方数据