麻醉方式对急性后循环脑卒中血管内治疗患者神经功能结局的影响
Effect of anesthesia mode during endovascular treatment on neurological functional outcomes in patients with acute posterior circulation stroke
朱晓锋 1张哲宇 2钟晚思 2贺耀德 2罗钟毓 2张凝远 3程超婵 4杨剑宏 5楼敏2
作者信息
- 1. 浙江大学医学院附属第二医院神经内科,浙江 杭州 310009;桐乡市第一人民医院神经内科,浙江 嘉兴 314500
- 2. 浙江大学医学院附属第二医院神经内科,浙江 杭州 310009
- 3. 桐乡市第一人民医院神经内科,浙江 嘉兴 314500
- 4. 永康市第一人民医院神经内科,浙江 金华 321300
- 5. 宁波市第一医院神经内科,浙江 宁波 315010
- 折叠
摘要
目的:比较急性后循环缺血性脑卒中患者在血管内治疗时选择清醒镇静和全身麻醉两种方式对患者神经功能结局的影响.方法:回顾性分析2017年1 月至2022年12月在急性卒中质量评估与管理在线数据库(来源于CASE-Ⅱ研究,NCT04487340)登记的656例急性后循环脑卒中血管内治疗患者的临床资料,根据麻醉方式不同分为清醒镇静组(163例)和全身麻醉组(493例).倾向性评分匹配后428例患者纳入分析,其中清醒镇静组(155例),全身麻醉组(273例).比较两组手术方式、病因分型、血管再通情况、24 h出血转化、3个月改良Rankin量表(mRS)评分和3个月死亡的差异,采用二元logistic回归分析不同麻醉方式对神经功能结局等的影响.结果:倾向性评分匹配后,清醒镇静与全身麻醉患者除手术方式差异有统计学意义(P<0.01),两组病因分型、血管再通情况、出血转化、3个月mRS评分和3个月死亡差异均无统计学意义(均P>0.05).二元logistic回归分析结果显示,清醒镇静与全身麻醉患者在血管内治疗后良好功能结局方面差异无统计学意义(OR=1.151,95%CI:0.751～1.765,P>0.05),在患者3个月mRS评分3分及以下、3个月mRS评分4分及以下、3个月死亡、血管再通良好和24 h出血转化方面差异也无统计学意义(均P>0.05).结论:对于接受血管内治疗的后循环脑卒中患者,采用清醒镇静或全身麻醉对患者神经功能结局无明显影响.
Abstract
Objective:To compare the effect of anesthesia mode on the neurological functional outcomes in patients undergoing endovascular treatment for acute posterior circulation ischemic stroke.Methods:Clinical data of 656 patients undergoing intravascular therapy for acute posterior circulation ischemic stroke registered in online Acute Stroke Patients for Stroke Management Quality Evaluation Database from January 2017 to December 2022 were retrospectively analyzed.The data included 163 cases with conscious sedation and 493 cases with general anesthesia during the procedure.After propensity score matching,428 patients were included in the analysis,including 155 cases in the conscious sedation group and 273 cases in the general anesthesia group.The differences of operation mode,etiology type,vascular recanalization,hemorrhagic transformation at 24 h,modified Rankin Scale(mRS)score at 3 months and mortality within 3 months were compared between the two groups.Binary logistic regression was used to explore the effect of different anesthesia mode on neurological functional outcomes.Results:There was a significant difference in operation mode between the two groups(P<0.01),while there were no significant differences in etiology type,vascular recanalization,hemorrhagic transformation at 24 h,mRS score at 3 months or mortality within 3 months(all P>0.05).Binary logistic regression analysis revealed that anesthesia modes were not significantly associated with functional outcomes of patients(OR=1.151,95%CI:0.751-1.765,P>0.05).Conclusion:Anesthesia mode(conscious sedation or general anesthesia)will not affect the neurological functional outcomes in patients with acute posterior circulation ischemic stroke undergoing endovascular treatment.
关键词
脑卒中/血管内治疗/全身麻醉/清醒镇静/回顾性研究Key words
Stroke/Endovascular treatment/General anesthesia/Conscious sedation/Retrospective study引用本文复制引用
基金项目
国家自然科学基金(81971101)
国家自然科学基金(82171276)
出版年
2024
NETL
NSTL
维普
万方数据