全身麻醉转化对急性脑卒中患者机械取栓术后神经功能的影响

doi:10.3969/j.issn.1006-7795.2023.02.009

摘要/Abstract

摘要：

目的探讨急性缺血性脑卒中(acute ischemic stroke, AIS)患者机械取栓术时，紧急全身麻醉转化(emergency conversion to general anesthesia，EC-GA）对术后神经功能预后的影响及术中EC-GA的预测因素。方法本研究对2017年11月至2021年5月就诊于首都医科大学附属北京天坛医院行机械取栓的422例AIS患者进行回顾性分析，其中全身麻醉组(general anesthesia，GA）203例、非全身麻醉组(non-general anesthesia，non-GA）173例，EC-GA组46例。主要观察指标为患者术后90 d神经功能良好预后比例，即90 d 改良Rankin量表(Modified Rankin Scale， mRS)评分≤2的患者比例(mRS分0～2表示神经功能预后良好，mRS分3～6预后不良）。次要观察指标为时间指标［发病-入室时间(T1），入室-动脉穿刺时间(T2），动脉穿刺-血流再痛时间(T3）］，改良脑梗死溶栓分级(modified thrombolysis in cerebral infarction, mTICI）的良好比例(mTICI:0～2a再通不良；2b～3再通良好），病死率(出院病死率和90 d病死率），术后并发症(肺炎发生率和颅内出血发生率）及EC-GA的危险因素。结果 46例患者进行EC-GA，总体转化率为21.0%，其中前循环转化率约为19.0%，后循环转换率约为28.9%。3组患者在神经功能预后评分(90 d mRS）及良好预后比例(90 d mRS≤2）差异无统计学意义(P>0.05）；EC-GA未显著增加不良预后风险：与non-GA组比较，OR=1.538(95% CI：0.792~2.984)；与GA组比较，OR=1.315(95% CI：0.684~2.528）。多因素回归分析显示：入室美国国立卫生研究院脑卒中量表(National Institute of Health Stroke Scale，NIHSS）评分>15分时，术中EC-GA的风险显著增加，调整比值比(adjusted odds ratio， aOR）=2.005(95% CI： 1.035~3.881）。结论急性脑卒中患者行机械取栓治疗中，紧急全身麻醉转化未显著增加不良预后风险；入室NIHSS评分大于15分，与术中紧急全身麻醉转化风险相关。

关键词: 麻醉, 紧急全身麻醉转化, 急性脑卒中, 机械取栓, 神经功能预后

Abstract:

Objective To investigate the effects of emergency conversion to general anesthesia (EC-GA) on the neurological outcomes of patients with acute ischemic stroke (AIS) undergoing mechanical thrombectomy (MT) and predictors of EC-GA. Methods A retrospective analysis was conducted on 422 patients with AIS who underwent mechanical thrombectomy in Beijing Tiantan Hospital, Capital Medical University from November 2017 to May 2021, including 203 cases in general anesthesia (GA), 173 cases in non-general anesthesia (non-GA)， and 46 cases in EC-GA. The primary outcome was the proportion of patients with Modified Rankin Scale (mRS)≤2 (mRS≤2 means good outcomes of neurological function) at 90 d after the operation. The secondary outcomes included time index ［onset-entry angiographic room time (T1), entry angiographic room-arterial puncture time (T2), arterial puncture-blood flow reperfusion time (T3)］, modified thrombolysis in cerebral infarction (mTICI):(0－2a indicating poor recanalization; 2b－3 indicating good recanalization), mortality (mortality at discharge and 90 d), postoperative complications (incidence of pneumonia and intracranial hemorrhage) and the predictors of EC-GA. Results Forty-six patients were encountered EA-GA with an overall conversion rate of 21.0%. The conversion rate of AIS patients with anterior circulation occlusion was approximately 19.0%, and that of posterior circulation was approximately 28.9%. There was no statistically significant difference in 90 d mRS and the proportion of good outcome (90 d mRS≤ 2) among the three groups (P>0.05), and the EC-GA group did not have significantly worse outcome with odds ratios: OR=1.538 (95% CI 0.792－2.984), compared with the non-GA group; OR=1.315 (95% CI： 0.684－2.528), compared with the GA group. National Institute of Health Stroke Scale (NIHSS)>15 (entry into angiographic room) was a predictor for EC-GA with an adjusted odds ratio (aOR) =2.005 (95% CI：1.035－3.881). Conclusion Emergency conversion to general anesthesia did not significantly increase the poor outcome compared with the non-GA group and GA group. Admission NIHSS>15 is a predictor for EC-GA.

Key words: anesthesia, emergency conversion to general anesthesia, acute ischemic stroke, mechanical thrombectomy, neurological outcome

中图分类号:

梁发, 吴侑煊, 王鑫焱, 菅敏钰, 刘海洋, 韩如泉. 全身麻醉转化对急性脑卒中患者机械取栓术后神经功能的影响[J]. 首都医科大学学报, 2023, 44(2): 237-243.

Liang Fa, Wu Youxuan, Wang Xinyan, Jian Minyu, Liu Haiyang, Han Ruquan. Effects of emergency conversion to general anesthesia on neurological outcomes of patients with acute ischemic stroke undergoing mechanical thrombectomy[J]. Journal of Capital Medical University, 2023, 44(2): 237-243.

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