针对急性缺血性中风的内血管治疗以全身麻醉为基础的疗法进行比较:系统性审查和网络元分析
Eric Plitman1,2, Ayman Mohammed3, Wesley Rajaleelan4
1From the Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
Anesthesia and analgesia
|January 20, 2025
概括
无论是全静脉麻醉 (TIVA) 还是挥发性麻醉,都没有显著影响接受内血管治疗的急性缺血性中风患者的结果. 与全身麻醉相比,镇静也没有显示神经学结果或再通道化的显著差异.
科学领域:
- 神经科学是一个神经科学.
- 麻醉学 麻醉学
- 心血管研究研究心血管研究
背景情况:
- 大脑血液动力学在全静脉麻醉 (TIVA) 和基于挥发性的全麻醉之间有所不同.
- 接受内血管治疗 (EVT) 的急性缺血性中风患者需要仔细的麻醉管理.
- 在EVT中比较TIVA和挥发性麻醉对于优化患者护理至关重要.
研究的目的:
- 在急性缺血性中风中接受EVT的患者中,比较基于TIVA和基于挥发性的全身麻醉的疗效.
- 评估不同麻醉方案对功能结果,死亡率和再通道化率的影响.
- 评估全身麻醉或有意识镇静是否在急性缺血性中风中对EVT优越.
主要方法:
- 在六个主要数据库 (MEDLINE,Embase,Cochrane,CINAHL,Web of Science,Scopus) 进行系统的文献搜索.
- 包括成人急性缺血性中风患者的英语语言研究,这些患者在TIVA或挥发性全身麻醉下接受EVT.
- 网络元分析以比较TIVA,挥发性麻醉和有意识镇静之间的结果 (修改的兰金尺度≤2在90天).
主要成果:
- 15项涉及3015名患者的研究符合纳入标准.
- 在90天的神经结果,死亡率,成功的再通道化或再通道化时间方面,在TIVA和挥发性麻醉之间没有发现显著差异.
- 在将意识镇静与TIVA或挥发性麻醉进行比较时,没有观察到对评估结果的显著差异.
结论:
- 术后使用TIVA,挥发性麻醉或有意识镇静并没有显著影响急性缺血性中风的内血管治疗结果.
- 该研究不足以检测麻醉剂,患者特征或程序因素的微妙差异.
- 需要进一步研究更大的样本大小,以阐明EVT麻醉选择中的潜在微小差异.
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