清醒镇静在急性缺血性脑卒中血管内治疗中的应用效果及预后影响评估

doi:10.3969/j.issn.1006-7795.2023.01.011

首都医科大学学报 ›› 2023, Vol. 44 ›› Issue (1): 72-77.doi: 10.3969/j.issn.1006-7795.2023.01.011

• 脑血管病的基础与临床研究 • 上一篇下一篇

清醒镇静在急性缺血性脑卒中血管内治疗中的应用效果及预后影响评估

姜富城^1#, 黄菊梅^1#, 冯跃先², 钟红亮¹, 贾建文¹, 杨洪超¹, 刘赫^1*, 刘扬^3*

1.首都医科大学附属北京朝阳医院神经外科,北京 100020;
2.三河燕郊福合第一医院急诊科,河北廊坊 065201;
3.首都医科大学附属北京朝阳医院麻醉科,北京 100020

收稿日期:2022-10-18 出版日期:2023-02-21 发布日期:2023-01-13
作者简介:^#共同第一作者
基金资助:
首都卫生发展科研专项(首发2022-2Z-2039)。

The evaluation of the efficacy and prognosis of conscious sedation in endovascular treatment in acute ischemic stroke

Jiang Fucheng^1#, Huang Jyumei^1#, Feng Yuexian², Zhong Hongliang¹, Jia Jianwen¹, Yang Hongchao¹, Liu He^1*, Liu Yang^3*

1. Department of Neurosurgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China;
2. Department of Emergency, Sanhe Yanjiao Fuhe Hospital, Langfang 065201,Hebei Province, China;
3. Department of Neurosurgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China

Received:2022-10-18 Online:2023-02-21 Published:2023-01-13
Contact: *E-mail: 1515812733@qq.com,liuydoctor@sina.com
Supported by:
Capital's Funds for Health Improvement and Research (2022-2Z-2039).

摘要/Abstract

摘要： 目的分析清醒镇静(conscious sedation, CS)与转接全身麻醉(conversion to general anesthesia, CGA)在急性缺血性脑卒中(acute ischemic stroke,AIS)血管内治疗中的作用效果及对预后的影响。方法对2021年1月至2021年12月就诊于首都医科大学附属北京朝阳医院行血管内治疗的117例AIS患者进行回顾性分析,根据患者麻醉方式的不同将患者分为2组:CS组(97例)和CGA组(20例)。分别比较两组患者的一般资料、入院时美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale, NIHSS)评分、大血管闭塞位置、关键时间节点、手术后脑灌注、并发症以及预后情况。为控制混杂因素对基线影响,对患者的基线数据采用倾向性评分进行1∶3配对。结果应用倾向性评分进行1∶3配比后CS组60人,CGA组20人,两组患者基线资料差异无统计学意义(P>0.05)。与CGA组相比,CS组穿刺至血管再通时间较短(P=0.007),两组患者血管闭塞位置差异有统计学意义(P=0.017),其中CGA组椎动脉闭塞发生率较高。两组患者入院至腹股沟穿刺时间(door to puncture,DTP)与术后改良脑梗死溶栓(modified thrombolysis in cerebral infarction, mTICI)分级差异无统计学意义(P>0.05)。与CGA组相比,CS组术后恶性脑水肿及坠积性肺炎发生率较低(P<0.05),预后良好率较高(P=0.019)。结论在AIS的血管内治疗中,CS简便有效,相比于CGA患者,能够更快地获得脑组织再灌注,并与更好的临床预后相关。

关键词: 急性缺血性脑卒中, 机械取栓, 右美托咪定, 清醒镇静, 全身麻醉

Abstract: Objective To analyze the effect and impact on prognosis of conscious sedation (CS) and conversion to general anesthesia (CGA) in endovascular treatment of acute ischemic stroke (AIS). Methods A retrospective analysis was conducted on 117 AIS patients who received endovascular therapy in Beijing Chaoyang Hospital, Capital Medical University from January 2021 to December 2021. The patients were divided into 2 groups according to anesthesia methods: CS (n=97) and CGA (n=20). General data, admission National Institutes of Health Stroke Scale (NIHSS), site of occlusion vessels, time course, the technical efficacy of the endovascular procedure in establishing reperfusion, complications and prognosis were compared between the two groups. The 1∶3 propensity score matching was calculated from the patients' base line data, so that the number of CS group was adjusted to 60 and CGA 20. Results The CS group had a significantly shorter time of puncture to recanalization (P=0.007). There was a statistically significant difference in the location of vascular occlusion between the two groups (P=0.017), and the incidence of vertebral artery occlusion was higher in the CGA group. There was no significant difference indoor to puncture(DPT) and postoperative modified thrombolysis in cerebral infarction(mTICI )between two groups (P>0.05). CS group had a significantly lower prevalence of postoperative malignant edema and hypostatic penumbra(P<0.05), and a significantly higher rate of good prognosis (P=0.019). Conclusion In the endovascular treatment of AIS, CS is simple and effective. Compared with CGA patients, it can achieve faster reperfusion and is associated with a better clinical prognosis.

Key words: acute ischemic stroke (AIS), mechanical thrombectomy (MT), dexmedetomidine, conscious sedation (CS), general anesthesia (GA)

中图分类号:

R743.3

姜富城, 黄菊梅, 冯跃先, 钟红亮, 贾建文, 杨洪超, 刘赫, 刘扬. 清醒镇静在急性缺血性脑卒中血管内治疗中的应用效果及预后影响评估[J]. 首都医科大学学报, 2023, 44(1): 72-77.

Jiang Fucheng, Huang Jyumei, Feng Yuexian, Zhong Hongliang, Jia Jianwen, Yang Hongchao, Liu He, Liu Yang. The evaluation of the efficacy and prognosis of conscious sedation in endovascular treatment in acute ischemic stroke[J]. Journal of Capital Medical University, 2023, 44(1): 72-77.

参考文献

[1] Alsrouji O K, Chebl A B. Acute neurointervention for ischemic stroke[J]. Interv Cardiol Clin, 2022, 11(3): 339-347.
[2] Jadhav A P, Desai S M, Jovin T G. Indications for mechanical thrombectomy for acute ischemic stroke: current guidelines and beyond[J]. Neurology, 2021, 97(20 Suppl 2): S126-S136.
[3] 中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组, 中华医学会神经病学分会神经血管介入协作组. 中国急性缺血性卒中早期血管内介入诊疗指南2022[J]. 中华神经科杂志, 2022, 55(6): 565-580.
[4] Powers W J, Rabinstein A A, Ackerson T, et al. 2018 guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J]. Stroke, 2018, 49(3): e46-e110.
[5] Campbell B C V, Van Zwam W H, Goyal M, et al. Effect of general anaesthesia on functional outcome in patients with anterior circulation ischaemic stroke having endovascular thrombectomy versus standard care: a meta-analysis of individual patient data[J]. Lancet Neurol, 2018, 17(1): 47-53.
[6] Feil K, Herzberg M, Dorn F, et al. General anesthesia versus conscious sedation in mechanical thrombectomy[J]. J Stroke, 2021, 23(1): 103-112.
[7] Sørensen L H, Speiser L, Karabegovic S, et al. Safety and quality of endovascular therapy under general anesthesia and conscious sedation are comparable: results from the GOLIATH trial[J]. J Neurointerv Surg, 2019, 11(11): 1070-1072.
[8] Simonsen C Z, Yoo A J, Sørensen L H, et al. Effect of general anesthesia and conscious sedation during endovascular therapy on infarct growth and clinical outcomes in acute ischemic stroke: a randomized clinical trial[J]. JAMA Neurol, 2018, 75(4): 470-477.
[9] De Cassai A, Boscolo A, Tonetti T, et al. Assignment of ASA-physical status relates to anesthesiologists' experience: a survey-based national-study[J]. Korean J Anesthesiol, 2019, 72(1): 53-59.
[10] Rubiera M, Alvarez-Sabín J, Ribo M, et al. Predictors of early arterial reocclusion after tissue plasminogen activator-induced recanalization in acute ischemic stroke[J]. Stroke, 2005, 36(7): 1452-1456.
[11] Wu S M, Yuan R Z, Wang Y N, et al. Early prediction of malignant brain edema after ischemic stroke[J]. Stroke, 2018, 49(12): 2918-2927.
[12] Zaidat O O, Yoo A J, Khatri P, et al. Recommendations on angiographic revascularization grading standards for acute ischemic stroke: a consensus statement[J]. Stroke, 2013, 44(9): 2650-2663.
[13] Jahan R, Saver J L, Schwamm L H, et al. Association between time to treatment with endovascular reperfusion therapy and outcomes in patients with acute ischemic stroke treated in clinical practice[J]. JAMA, 2019, 322(3): 252-263.
[14] 国家卫生健康委脑卒中防治工程专家委员会, 国家卫生健康委脑卒中防治工程委员会医院管理委员会, 国家卫生健康委脑卒中防治工程专家委员会急诊专业委员会. 新型冠状病毒肺炎疫情时期脑卒中绿色通道管理专家共识[J]. 首都医科大学学报, 2020, 41(2): 293-297.
[15] Simonsen C Z, Schönenberger S, Hendén P L, et al. Patients requiring conversion to general anesthesia during endovascular therapy have worse outcomes: a post Hoc analysis of data from the SAGA collaboration[J]. AJNR Am J Neuroradiol, 2020, 41(12): 2298-2302.
[16] Flottmann F, Leischner H, Broocks G, et al. Emergency conversion to general anesthesia is a tolerable risk in patients undergoing mechanical thrombectomy[J]. AJNR Am J Neuroradiol, 2020, 41(1): 122-127.
[17] 杜娟, 林甜, 崔永强, 等. 急性基底动脉闭塞性脑梗死取栓治疗中不同麻醉方式对预后影响的初步分析[J]. 中国脑血管病杂志, 2020, 17(9): 497-504, 552.
[18] Tasbihgou S R, Barends C R M, Absalom A R. The role of dexmedetomidine in neurosurgery[J]. Best Pract Res Clin Anaesthesiol, 2021, 35(2): 221-229.
[19] Ren C G, Xu G J, Liu Y C, et al. Effect of conscious sedation vs. General anesthesia on outcomes in patients undergoing mechanical thrombectomy for acute ischemic stroke: a prospective randomized clinical trial[J]. Front Neurol, 2020, 11: 170.
[20] Bekelis K, Missios S, MacKenzie T A, et al. Anesthesia technique and outcomes of mechanical thrombectomy in patients with acute ischemic stroke[J]. Stroke, 2017, 48(2): 361-366.
[21] Schönenberger S, Uhlmann L, Hacke W, et al. Effect of conscious sedation vs general anesthesia on early neurological improvement among patients with ischemic stroke undergoing endovascular thrombectomy: a randomized clinical trial[J]. JAMA, 2016, 316(19): 1986-1996.
[22] Salsano G, Pracucci G, Mavilio N, et al. Complications of mechanical thrombectomy for acute ischemic stroke: incidence, risk factors, and clinical relevance in the Italian Registry of Endovascular Treatment in acute stroke[J]. Int J Stroke, 2021, 16(7): 818-827.

清醒镇静在急性缺血性脑卒中血管内治疗中的应用效果及预后影响评估

The evaluation of the efficacy and prognosis of conscious sedation in endovascular treatment in acute ischemic stroke

PDF

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 8

编辑推荐

Metrics

本文评价

[1]	李森, 郭学文, 赵鑫, 黄安琪, 林婧格, 李兴茂, 李秀, 杜怡峰, 赵咏梅, 白洁, 夏章勇. 急性缺血性脑卒中合并糖尿病人群的血糖变异性与神经功能恶化的相关性分析[J]. 首都医科大学学报, 2023, 44(1): 78-84.
[2]	马佳佳, 岳红丽, 王德祥, 金旭, 韩如泉. 不同剂量右美托咪定对儿童颅脑术后苏醒期躁动的影响[J]. 首都医科大学学报, 2021, 42(3): 459-463.
[3]	张菊霞, 黄枭, 吴安石. HTP102型无创鼓膜温度持续监测装置在不停跳冠状动脉旁路移植术中的应用[J]. 首都医科大学学报, 2020, 41(4): 617-621.
[4]	侯瑞雪, 尹橙, 王天龙. 全身麻醉或联合颈丛阻滞用于甲状腺手术术后镇痛效果的观察[J]. 首都医科大学学报, 2020, 41(2): 253-256.
[5]	马艳辉, 吴迪, 田肇隆, 贾宾, 徐娜, 陈健, 王天龙. 两种麻醉方法用于恒河猴急性脑梗死模型麻醉效果的比较[J]. 首都医科大学学报, 2018, 39(4): 552-556.
[6]	赵立红, 尹宁宁, 李倩, 陈晗, 史中华, 徐明, 石广志, 周建新. 右美托咪定对开颅术后延迟拔管患者应激性激素和血流动力学的影响[J]. 首都医科大学学报, 2015, 36(6): 964-968.
[7]	郑增旺;王克杰. 咪达唑仑和丙泊酚用于全身麻醉效果的比较[J]. 首都医科大学学报, 2006, 27(3): 386-388.
[8]	郑铁华;张建敏;高铁光;王芳;王萍;张金哲. 儿童腹腔镜精索静脉结扎术硬膜外麻醉和全身麻醉的比较[J]. 首都医科大学学报, 2005, 26(4): 498-501.