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在血栓切除术患者中,全身麻醉与有意识镇静相比,NIHSS前部循环低的患者中风

Christian Heitkamp¹, Fabian Flottmann¹, Tobias D Faizy^1,2

¹Departments of Neuroradiology (C.H., F.F., T.D.F., A.H., C.T., V.G., H.C.K., G.B., M.B., L.M., U.H., J.F., L.W.), University Medical Center Hamburg-Eppendorf, Germany.

|March 25, 2025

概括

对于接受机械血栓切除术的急性缺血性中风患者,有意识的镇静/局部麻醉 (CS/LA) 显示了与全身麻醉 (GA) 相比的可比性回率. CS/LA与更好的功能结果有关,这表明有利的风险/收益概况.

科学领域:

神经学神经学
干预性神经放射学干预性神经放射学
麻醉学麻醉学

背景情况:

对于急性缺血性中风的最佳麻醉策略,大血管封闭和接受机械血栓切除术的NIHSS得分低,尚未确定.
意识镇静/局部麻醉 (CS/LA) 假设在这些患者中,与全身麻醉 (GA) 相比,提供更好的风险效益比率.

研究的目的:

评估麻醉策略 (CS/LA vs. GA) 与急性缺血性中风和大血管封闭,但NIHSS得分低的机械血栓切除术患者的程序和临床结果的关联.

主要方法:

多中心队列研究使用德国中风注册-内血管治疗 (GSR-ET) 数据库 (2015-2021).
对于NIHSS<6和前部循环大血管封闭的患者,进行了倾向性得分匹配 (1:1),并比较了CS/LA和GA组.
主要结局包括卓越的功能结局 (修改的兰金尺度0-1在90天) 和成功的再通道化 (修改的脑梗塞中血栓溶解2b-3).

主要成果:

在对582名患者进行匹配后,CS/LA和GA组之间的基线和成像特征平衡.
在CS/LA (85%) 和GA (89%) (P=0.14) 之间,成功的再通道化率相似.
CS/LA与较低的完全再通道化率 (45%与61%相比;P<0.001) 相关,但具有较高的优秀功能结果率 (59%与48%相比;P=0.005).

结论:

在发生轻微中风的机械血栓切除术患者中,CS/LA和GA产生了相似的成功再通道化率.
CS/LA表现出更有利的风险/收益概况,与卓越功能结果的可能性增加有关.

关键词:

血管造影 - 血管造影队列研究是指队列研究.登记处登记处登记处登记处一次性中风中风中风中风中风进行血栓切除术 (thrombectomy).

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