总麻醉与意识镇静对急性缺血性中风内血管治疗:随机对照试验的元分析
Mohammed Maan Al-Salihi1, Ram Saha2, Ali Ayyad3
1Department of Neurological Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA.
World neurosurgery
|November 6, 2023
概括
全身麻醉 (GA) 是一种全身麻醉. 在急性缺血性中风 (AIS) 内血管内血栓切除术期间,与有意识镇静 (CS) 相比,显示出更高的回通率. 然而,功能结果和死亡率相似,这表明需要进一步研究以选择最佳麻醉剂.
科学领域:
- 神经学 神经学
- 干预心脏病学 干预心脏病学
- 麻醉学 麻醉学
背景情况:
- 血管内血栓切除术 (E.V.T.) 是一种治疗方法. 是急性缺血性中风 (AIS) 的标准治疗方法.
- 在E.V.T.的最佳麻醉方法. 在AIS患者中仍在进行研究.
- 这一系统性审查和元分析综合了随机对照试验 (RCT) 的证据.
研究的目的:
- 为了比较全身麻醉 (GA) 的疗效和安全性. 与有意识的镇静 (CS) 相比. 在E.V.T.期间. 对于AIS来说.
- 为接受E.V.T.的AIS患者选择最合适的麻醉方式提供指导.
- 总结来自RCT的现有文献.
主要方法:
- 系统的文献搜索与G.A.比较的RCT. 和C.S.以及C.S. 在E.V.T.中 对于AIS来说.
- 独立选和从符合条件的研究中提取数据.
- 使用风险比率和平均差异进行聚合分析;通过Cochrane风险偏差工具进行质量评估.
主要成果:
- 功能独立性 (mRS 0-2) 在G.A.之间没有显著差异. 和C.S.以及C.S. (RR 1.10 [0.95,1.27],P=0.19) 的情况.
- 优秀的 (mRS 0-1) 和差的 (≥3) 恢复结果也没有显著差异.
- 成功的再通道是显著高于GAGA. 与C.S.相比,这是一个很好的选择. (RR 1.13 [1.07,1.20],P<0.001) 的情况.
结论:
- 在接受E.V.T.的AIS患者中,全身麻醉显示出更高的再通道化率.
- 功能性结局,死亡率和NIHSS分数在GA之间是可比的. 和C.S.以及C.S.
- 与GA一起观察到较高的低血压风险. 需要进一步的试验来确定最佳的麻醉方法.
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