清醒镇静在急性缺血性脑卒中血管内治疗中的应用效果及预后影响评估

The evaluation of the efficacy and prognosis of conscious sedation in endovascular treatment in acute ischemic stroke

目的分析清醒镇静(conscious sedation,CS)与转接全身麻醉(conversion to general anesthesia,CGA)在急性缺血性脑卒中(acute ischemic stroke,AIS)血管内治疗中的作用效果及对预后的影响。方法对2021年1月至2021年12月就诊于首都医科大学附属北京朝阳医院行血管内治疗的117例AIS患者进行回顾性分析,根据患者麻醉方式的不同将患者分为2组:CS组(97例)和CGA组(20例)。分别比较两组患者的一般资料、入院时美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分、大血管闭塞位置、关键时间节点、手术后脑灌注、并发症以及预后情况。为控制混杂因素对基线影响,对患者的基线数据采用倾向性评分进行1∶3配对。结果应用倾向性评分进行1∶3配比后CS组60人,CGA组20人,两组患者基线资料差异无统计学意义(P>0.05)。与CGA组相比,CS组穿刺至血管再通时间较短(P=0.007),两组患者血管闭塞位置差异有统计学意义(P=0.017),其中CGA组椎动脉闭塞发生率较高。两组患者入院至腹股沟穿刺时间(door to puncture,DTP)与术后改良脑梗死溶栓(modified thrombolysis in cerebral infarction,mTICI)分级差异无统计学意义(P>0.05)。与CGA组相比,CS组术后恶性脑水肿及坠积性肺炎发生率较低(P<0.05),预后良好率较高(P=0.019)。结论在AIS的血管内治疗中,CS简便有效,相比于CGA患者,能够更快地获得脑组织再灌注,并与更好的临床预后相关。

Objective To analyze the effect and impact on prognosis of conscious sedation(CS)and conversion to general anesthesia(CGA)in endovascular treatment of acute ischemic stroke(AIS).Methods A retrospective analysis was conducted on 117 AIS patients who received endovascular therapy in Beijing Chaoyang Hospital,Capital Medical University from January 2021 to December 2021.The patients were divided into 2 groups according to anesthesia methods:CS(n=97)and CGA(n=20).General data,admission National Institutes of Health Stroke Scale(NIHSS),site of occlusion vessels,time course,the technical efficacy of the endovascular procedure in establishing reperfusion,complications and prognosis were compared between the two groups.The 1∶3 propensity score matching was calculated from the patients’base line data,so that the number of CS group was adjusted to 60 and CGA 20.Results The CS group had a significantly shorter time of puncture to recanalization(P=0.007).There was a statistically significant difference in the location of vascular occlusion between the two groups(P=0.017),and the incidence of vertebral artery occlusion was higher in the CGA group.There was no significant difference indoor to puncture(DPT)and postoperative modified thrombolysis in cerebral infarction(mTICI)between two groups(P>0.05).CS group had a significantly lower prevalence of postoperative malignant edema and hypostatic penumbra(P<0.05),and a significantly higher rate of good prognosis(P=0.019).Conclusion In the endovascular treatment of AIS,CS is simple and effective.Compared with CGA patients,it can achieve faster reperfusion and is associated with a better clinical prognosis.