大血管封闭的麻醉管理急性缺血性中风与合病变
Mudassir Farooqui1, Milagros Galecio-Castillo1, Ameer E Hassan2
1Neurology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
Journal of neurointerventional surgery
|March 1, 2024
概括
与全身麻醉 (GA) 相比,手术镇静 (PS) 与急性缺血性中风患者进行内血管治疗 (EVT) 的更好的功能结果有关. 这表明重新考虑麻醉策略,以改善患者的康复.
科学领域:
- 神经学 神经学
- 干预性放射学 干预性放射学
- 麻醉学 麻醉学
背景情况:
- 内血管治疗 (EVT) 是有效的急性缺血性中风与合病变 (TLs).
- 在TL患者中,EVT的最佳麻醉策略尚不清楚.
- 这项研究评估了麻醉技术对TL患者EVT结果的影响.
研究的目的:
- 为了比较一般麻醉 (GA) 与手术镇静 (PS) 在急性缺血性中风患者的EVT的结果.
- 确定最佳的麻醉方法,以改善功能结果和程序安全.
主要方法:
- 来自16个中心 (2015年1月至2020年12月) 的前部循环TL的综合患者级数据.
- 分层分析比较GA和PS组.
- 多变量逻辑回归以评估结果:功能性结果 (90天的mRS 0-2),症状性内出血 (sICH),再通道成功 (mTICI ≥2b),死亡率和手术时间.
主要成果:
- 与全身麻醉 (GA) 相比,手术镇静 (PS) 与有利的功能结果 (aOR 0.56) 和有利的90天mRS转移 (aOR 0.71) 的几率明显更高.
- 在GA和PS之间的手术时间,sICH,成功的再通道化或90天死亡率方面没有观察到显著的差异.
- 亚组分析表明,PS在年轻患者 (≤70岁),NIHSS得分较低的患者 (<15) 和接受急性ICA支架的患者中提供了更好的结果.
结论:
- 程序性镇静 (PS) 在TLs的EVT期间表现出与全身麻醉 (GA) 相当的安全性.
- 在这种患者群体中,PS与卓越的功能结果有关.
- 这些发现提倡重新评估当前的麻醉实践,考虑患者特定因素以制定最佳的EVT策略.
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