在急性中风A次分析的内支架内内麻醉方式的RESISTANT国际注册表
João André Sousa1,2, Marta Olivé-Gadea3, Francesco Diana3,4
1Stroke Unit, Hospitais da Universidade de Coimbra, Coimbra, Portugal. sousajoaoandre@gmai.com.
Clinical neuroradiology
|February 3, 2026
概括
总麻醉 (GA) 在中风血栓切除过程中没有改善内支架的结果. 然而,GA与增加的死亡率有关,这表明局部麻醉或有意识的镇静可能是可取的.
科学领域:
- 神经学 神经学
- 麻醉学 麻醉学
- 干预性神经放射学 干预性神经放射学
背景情况:
- 对于急性中风患者在血栓切除术期间进行内支架的最佳麻醉管理尚未得到充分确立.
- 这项研究解决了围绕整体麻醉 (GA) 与局部麻醉或意识镇静在这个关键患者群体的不确定性.
研究的目的:
- 为了比较全身麻醉 (GA) 与局部麻醉或有意识镇静的临床结果和安全性,在接受急性中风内支架的患者中.
- 评估麻醉方法对功能独立,再注射和安全结果的影响.
主要方法:
- 一项使用RESISTANT注册表的多中心观察研究包括在2016年1月至2023年6月期间接受治疗的876名患者.
- 患者被分为GA和局部麻醉/有意识镇静组. 主要结局是90天修改的兰金尺度 (mRS) 转移;次要结局包括mRS 0-2,mTICI 2c/3分数,症状内出血 (sICH) 和死亡率.
- 用混合效应模型进行调整后回归分析,以控制混因素.
主要成果:
- 在90天的mRS,功能独立 (mRS 0-2),或在GA和局部麻醉/有意识镇静组之间成功的再输液 (mTICI 2c/3) 之间没有观察到显著差异.
- 在两组麻醉者之间,症状性内出血 (sICH) 的发生率是可比的.
- 与接受局部麻醉或有意识镇静的患者相比,接受GA的患者在医院和90天死亡率显著更高.
结论:
- 麻醉方式 (全身麻醉与局部麻醉/有意识镇静) 并没有影响急性中风的内支架患者的功能结果或再输血成功.
- 全身麻醉与死亡率的增加有关,可能是由于指示偏差而不是麻醉技术本身.
- 这些发现表明,局部麻醉或有意识的镇静可能是血栓切除术期间内支架的更安全的替代方案,这需要进一步调查指示偏差.
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