不同麻醉方式对急性缺血性脑卒中患者行血管内机械取栓治疗影响的回顾性分析

Retrospective analysis of the influence of different anesthesia methods on mechanical thrombectomy in patients with acute ischemic stroke

目的探讨不同麻醉方式下急性缺血性脑卒中(acute ischemic stroke,AIS)患者行血管内机械取栓治疗后短期预后及其相关危险因素。方法回顾2013年5月至2017年7月海军军医大学第一附属医院收治并完成血管内机械取栓手术的AIS患者284例,针对一般资料和疾病状态,对实施全身麻醉的患者与保留自主呼吸的镇静处理或局部麻醉的患者对比,分析手术麻醉相关信息。结果术前2组患者脑卒中OCSP分型有不同表现,NIHSS分值全麻组高于非全麻组,差异有统计学意义(P<0.05),全麻患者意识水平危重比例较非全麻组高(P<0.05);术后2 h及24 h患者NIHSS评分全麻组得分仍高于非全麻组(P<0.05)。2组患者从发病到血管再通时间及从穿刺到再通时间全麻组患者均较长(P<0.05)。全麻组麻醉诱导实施时间也明显长于非全麻组(P<0.05)。术后3个月评估发现,患者神经功能结果可见术前NIHSS评分越高,术后患者神经功能损伤越严重(OR=1.098,95%CI 1.037~1.162);年龄越大术后患者康复程度越差(OR=1.030,95%CI 1.007~1.053);穿刺至血管再通时间越长术后功能损伤越严重(OR=1.006,95%CI 1.001~1.011)。结论术前疾病严重程度、年龄及穿刺至血管再通时间严重影响AIS患者预后,是否与麻醉方式相关需进一步研究。

Objective To explore the short-term prognosis of patients with acute ischemic stroke(AIS)treated with intravascular mechanical thrombolysis under different anesthesia methods and its related risk factors.Methods The AIS patients admitted to our hospital from May 2013 to July 2017 who underwent endovascular mechanical thrombolysis were reviewed.According to the general data and disease status,the patients who underwent general anesthesia were compared with the patients who underwent sedation or local anesthesia with spontaneous breathing retained,and the information related to surgical anesthesia was analyzed.Results The preoperative OCSP classification of stroke patients in the two groups showed different manifestations.The NIHSS score in the general anesthesia group was higher than that in the non-general anesthesia group with a significant statistical difference(P<0.05).The proportion of critical consciousness level in the general anesthesia group was higher than that in the non-general anesthesia group(P<0.05);NIHSS score at 2 h(P<0.05)and 24 h(P<0.05)after surgery was still higher in the general anesthesia group than that in the non-general anesthesia group.The time from onset to recanalization(P<0.05)and from puncture to recanalization(P<0.05)in the general anesthesia group was longer than that in the non-general anesthesia group.The duration of anesthesia induction in the general anesthesia group was also significantly longer than that in the non-general anesthesia group(P<0.05).The results showed that higher preoperative NIHSS score was associated with more serious postoperative neurological impairment(OR=1.098,95%CI 1.037-1.162)and worse postoperative rehabilitation with the increase of age(OR=1.030,95%CI 1.007-1.053),and it was also found that longer time between puncture and recanalization was associated with more serious postoperative functional damage(OR=1.006,95%CI 1.001-1.011).Conclusions Preoperative disease severity,age,and the time from puncture to recanalization seriously affect the prognosis of AIS patients,and whether it is related to anesthesia method needs to be further studied.