镇静与全身麻醉用于急性缺血性中风的内血管治疗:SEGA随机临床试验
Peng Roc Chen1, Carlos A Artime2, Sunil A Sheth3
1Department of Neurosurgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston.
JAMA neurology
|October 13, 2025
概括
一般麻醉 (GA) 改善了急性缺血性中风 (AIS) 患者的90天功能结果,这些患者接受大血管封闭 (LVO) 内血管治疗 (EVT). 与中度镇静相比,GA还导致更高的成功再输率.
科学领域:
- 神经学 神经学
- 麻醉学 麻醉学
- 干预心脏病学 干预心脏病学
背景情况:
- 由于大血管封闭 (LVO) 而导致的急性缺血性中风 (AIS) 中内血管治疗 (EVT) 的最佳麻醉方法尚未确立.
- 在全身麻醉 (GA) 和中度镇静之间做出选择可以影响LVO的EVT后的患者结果.
研究的目的:
- 为了比较接受EVT的AIS和LVO患者的90天功能结果.
- 为了确定全身麻醉 (GA) 或中度镇静是否与LVO的EVT后更好的功能结果有关.
主要方法:
- 一个多中心随机临床试验,涉及260名因LVO而患有AIS的患者.
- 患者被随机分配 (1:1) 接受中度镇静或全身麻醉 (GA).
- 主要结局是90天后的顺序修改的兰金表 (mRS) 评分.
主要成果:
- 与中度镇静相比,全身麻醉 (GA) 在90天修改的兰金尺度 (mRS) 分布上显示出有利的转变 (OR,1.22,81%的优势概率).
- 在90天的mRS得分为0到2时,GA的优势概率为89% (RR,1.2).
- 与中度镇静相比,GA的成功再输率更高 (69%的优势概率).
结论:
- 在接受EVT的LVO AIS患者中,全身麻醉 (GA) 与90天功能结果的改善和更高的成功再输血率有关.
- 这些发现表明GA可能是这种患者群体中EVT的首选麻醉策略.
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