麻醉方式选择对急性前循环大血管闭塞性卒中血管内治疗预后的影响

Effect of anesthesia selection on endovascular treatment for anterior circulation major vessel occlusion stroke

目的评估麻醉方式对急性前循环大血管闭塞性卒中血管内治疗预后的影响。方法回顾2016年1月至2016年8月在我院行血管内治疗的急性前循环大血管闭塞性卒中患者的临床资料，依据麻醉方式将患者分为全身麻醉组和清醒镇静组，对比分析两组在时间、症状性颅内出血及90 d功能预后方面的差异。结果共有73例患者的临床资料被纳入分析，其中全身麻醉组34例（46.6%），清醒镇静组39例（53.4%）。两组基线临床资料差异无统计学意义，两组到院至穿刺时间、穿刺至再通时间及发病至再通时间差异均无统计学意义，全身麻醉组术后收缩压显著低于清醒镇静组[分别为（126.29±20.07）、（139.95±21.22）mmHg（1 mmHg=0.133 kPa）, t=2.81, P=0.01]，两组成功再灌注率（改良脑梗死溶栓分级≥2b）[分别为94.1%（32/34）、87.2%（34/39）, χ^2=0.33, P=0.57）、症状性颅内出血率[分别为17.6%（6/34）、10.3%（4/39）, χ^2=0.33, P=0.57]及90 d良好预后率（改良Rankin量表评分≤2分）[分别为41.2%（14/34）、53.8%（21/39）, χ^2=1.17, P=0.28]差异均无统计学意义。结论选择全身麻醉或清醒镇静对前循环大血管闭塞血管内治疗预后影响无差异，结果仍需大样本随机对照研究进一步验证。

ObjectiveTo evaluate the effect of anesthesia selection on endovascular treatment for anterior circulation major vessel occlusion stroke.MethodsThe clinical data of patients undergoing endovascular treatment in our hospital from January 2016 to August 2016 were retrospectively reviewed. The patients were divided into general anesthesia group and conscious sedation group. Comparison of the differences in time, symptomatic intracranial hemorrhage, and 90-day functional outcome between the two groups was made.ResultsA total of 73 patients were included in the analysis, 34 （46.6%） in the general anesthesia group, and 39 （53.4%） in the conscious sedation group. The baseline clinical data were balanced in both groups. There was no statistically significant difference in door-to-puncture time, puncture-to-recanalization time and onset-to-recanalization time between the two groups. The postoperative systolic blood pressure was significantly decreased in the general anesthesia group （（126.29±20.07） vs （139.95±21.22） mmHg （1 mmHg=0.133 kPa）, t=2.81, P=0.01）, whereas the rate of successful reperfusion （modified thrombolysis in cerebral infarction ≥ 2b） （94.1%（32/34） vs 87.2%（34/39）, χ^2=0.33, P=0.57）, symptomatic intracranial hemorrhage rate （17.6%（6/34） vs 10.3%（4/39）, χ^2=0.33, P=0.57） and good outcome （modified Rankin Scale （mRS） score ≤ 2） at 90 days （41.2%（14/34） vs 53.8%（21/39）, χ2=1.17, P=0.28） did not show statistically significant difference between the two groups.ConclusionsThe selection of general anesthesia or conscious sedation had no significant effect on the outcome of endovascular treatment for anterior circulation major vascular occlusion stroke. The results of the study still need to be verified by large-scale randomized controlled trial.