不同手术麻醉方式对老年急性颈动脉闭塞介入开通的影响

Effect of different anesthesia methods on outcome of endovascular treatment in elderly acute carotid occlusion patients

目的比较全身麻醉与清醒镇静对老年急性颈动脉闭塞介入开通患者预后的影响。方法采用回顾性分析,纳入急性前循环缺血性脑卒中血管内治疗登记研究中的老年急性颈动脉闭塞介入开通患者155例,按照不同手术麻醉方式分为全身麻醉组24例和清醒镇静组131例。主要观察指标为90 d功能结局,采用改良的Rankin量表(modified Rankin’s scale,mRS)评分;其他次级观察指标包括24 h神经功能改善情况、颅内出血、肺炎、入院至股动脉穿刺时间、股动脉穿刺至再通时间、改良的脑梗死溶栓分级、住院期间及90 d死亡等。结果2组住院时间、改良的脑梗死溶栓分级、入院时美国国立卫生研究院卒中量表评分、入院24 h美国国立卫生研究院卒中量表评分、症状性颅内出血、无症状性颅内出血、蛛网膜下腔出血、肺炎、mRS评分、股动脉穿刺至再通时间、住院及90 d死亡比较,差异无统计学意义(P>0.05)。与全身麻醉组比较,清醒镇静组入院至股动脉穿刺时间更短[120.0(78.0,149.0)min vs 145.0(122.5,194.8)min,P=0.016]。结论老年急性颈动脉闭塞血管内介入治疗的围术期麻醉管理中,全身麻醉与清醒镇静对于患者神经功能恢复的影响无明显差异。

Objective To compare the effect of general anesthesia and conscious sedation on the outcome of endovascular treatment in elderly acute carotid occlusion patients.Methods One hundred and fifty-five elderly acute carotid occlusion patients admitted to our hospital for endovascular treatment of acute anterior circulation ischemic stroke were divided into general anesthesia group(n=24)and conscious sedation group(n=131).Their primary observational indicator was the 90-day functional outcome which was scored according to the modified Rankin’s scale(mRS).The other secondary observational indicators were the 24 h neurological function improvement,incidence of intracranial hemorrhage and pneumonia,time from admission to femoral artery puncture,time from femoral artery puncture to recanalization,modified thrombolysis classification for cerebral infarction,in-hospital and 90-day mortality.Results No significant difference was detected in hospital stay time,modified thrombolysis classification for cerebral infarction,national institutes of health stroke scale score on admission and at 24 h after admission,incidence of symptomatic and asymptomatic intracranial hemorrhage,subarachnoid hemorrhage and pneumonia,mRS score,time from femoral artery puncture to recanalization,in-hospital and 90-day mortality between the two groups(P>0.05).The time from admission to femoral artery puncture was significantly shorter in conscious sedation group than in general anesthesia group[120.0(78.0,149.0)min vs 145.0(122.5,194.8)min,P=0.016].Conclusion No significant difference is found in the effect of general anesthesia and conscious sedation on the recovery of neurological function in elderly acute carotid occlusion patients.