急性缺血性脑卒中血管内治疗的麻醉方式探讨

Investigation of the Anesthesia Method for Acute Ischemic Stroke with Endovascular Therapy

目的探讨并评估全身麻醉和局部麻醉两种麻醉方式在急性脑卒中患者行动脉内介入溶栓治疗的安全性及临床疗效。方法回顾性分析该科2013年1月—2015年1月接受介入血管内溶栓治疗的急性脑卒中患者126例,随访1~6个月。对术前及术后患者临床症状的改善,临床预后及DSA图像质量等资料进行分析比较。结果 126例患者中73例（58%）采用全身麻醉,53例（42%）接受局部麻醉。全身麻醉组中平均在ICU住院时间较局麻组长差异有统计学意义（6.5VS3.2 d,P〈0.05）。术中并发症的发生率全身麻醉组（1/73,1.4%）较局部麻醉组（4/53,7.5%）低,差异有统计学意义（P〈0.05）。在单变量及多变量的分析中,全麻组患者的住院死亡率较局麻组高,差异有统计学意义（OR=0.32,P〈0.05）,但全麻组的DSA图像质量、临床预后较局麻组更好,差异有统计学意义（OR=3.06,P〈0.05）最终脑梗塞的面积较局麻组小,差异有统计学意义（OR=0.25,P〈0.05）。结论在急性脑卒中血管内介入溶栓治疗中采用全身麻醉与局部麻醉的安全性相似,但在临床预后及DSA图像质量上全身麻醉更具优势。该研究属于回顾性分析,需通过大规模多中心实验来进一步验证。

Objective To evaluate the safety and clinical efficacy of general anesthesia（GA） and local anesthesia（LA） these two kinds of anesthesia used in intra-arterial interventional thrombolysis treatment for acute stroke patients.Methods A retrospective analysis was conducted on the 126 acute stroke patients underwent intra-arterial interventional thrombolysis treatment in our department from January 2013 to January 2015.AD of them were followed up for 1-6 months.The improvement in preoperative and postoperative clinical symptoms,clinical outcome and quality of DSA images and other data of the patients were analyzed and compared.Results Of the 126 patients,73 cases（58%） adopted GA,and 53 cases（42%） used LA.GA group had longer mean length of stay in the intensive care unit than the LA group[（6.5 vs 3.2） days,P〈0.05].The incidence of intraprocedural complications was lower in GA group than that in LA group[1/73（1.4%） vs 4/53（7.5%）],the difference was statistically significant（P〈0.05）.Univariate and multivariate analyses showed that,compared with LA group,GA group had higher in-hospital mortality（OR=0.32,P〈0.05）,but better quality of DSA images and clinical outcome（OR=3.06,P〈0.05）,and smaller final cerebral infarction volume（OR=0.25,P〈0.05）.Conclusion For acute stroke patients undergoing intra-arterial interventional thrombolysis treatment,the safety of general anesthesia is similar to that of local anesthesia,but general anesthesia is better in the aspects of chnical outcome and quality of DSA images,the view develops from this retrospective study and it needs to be verified further by larger multicenter trials.