血管内急性缺血性卒中治疗中清醒镇静与全身麻醉的比较：一项系统评价和荟萃分析。
Conscious sedation versus general anesthesia during endovascular acute ischemic stroke treatment: a systematic review and meta-analysis.
作者信息
Brinjikji W, Murad M H, Rabinstein A A, Cloft H J, Lanzino G, Kallmes D F
机构信息
From the Departments of Radiology (W.B., H.J.C., G.L., D.F.K.)
Center for the Science of Healthcare Delivery and the Division of Preventive Medicine (M.H.M.), Mayo Clinic, Rochester, Minnesota.
出版信息
AJNR Am J Neuroradiol. 2015 Mar;36(3):525-9. doi: 10.3174/ajnr.A4159. Epub 2014 Nov 13.
BACKGROUND AND PURPOSE
A number of studies have suggested that anesthesia type (conscious sedation versus general anesthesia) during intra-arterial treatment for acute ischemic stroke has implications for patient outcomes. We performed a systematic review and meta-analysis of studies comparing the clinical and angiographic outcomes of the 2 anesthesia types.
MATERIALS AND METHODS
In March 2014, we conducted a computerized search of MEDLINE and EMBASE for reports on anesthesia and endovascular treatment of acute ischemic stroke. Using random-effects meta-analysis, we evaluated the following outcomes: recanalization rate, good functional outcome (mRS ≤ 2), asymptomatic and symptomatic intracranial hemorrhage, death, vascular complications, respiratory complications, procedure time, time to groin, and time from symptom onset to recanalization.
RESULTS
Nine studies enrolling 1956 patients (814 with general anesthesia and 1142 with conscious sedation) were included. Compared with patients treated by using conscious sedation during stroke intervention, patients undergoing general anesthesia had higher odds of death (OR = 2.59; 95% CI, 1.87-3.58) and respiratory complications (OR = 2.09; 95% CI, 1.36-3.23) and lower odds of good functional outcome (OR = 0.43; 95% CI, 0.35-0.53) and successful angiographic outcome (OR = 0.54; 95% CI, 0.37-0.80). No difference in procedure time (P = .28) was seen between the groups. Preintervention NIHSS scores were available from 6 studies; in those, patients receiving general anesthesia had a higher average NIHSS score.
CONCLUSIONS
Patients with acute ischemic stroke undergoing intra-arterial therapy may have worse outcomes with general anesthesia compared with conscious sedation. However, the difference in stroke severity at the onset may confound the comparison in the available studies; thus, a randomized trial is necessary to confirm this association.
背景与目的
多项研究表明，急性缺血性卒中动脉内治疗期间的麻醉类型（清醒镇静与全身麻醉）对患者预后有影响。我们对比较这两种麻醉类型的临床和血管造影结果的研究进行了系统评价和荟萃分析。
材料与方法
2014年3月，我们对MEDLINE和EMBASE进行了计算机检索，以查找有关急性缺血性卒中麻醉和血管内治疗的报告。我们使用随机效应荟萃分析评估了以下结果：再通率、良好功能预后（改良Rankin量表评分≤2）、无症状和有症状颅内出血、死亡、血管并发症、呼吸并发症、手术时间、腹股沟穿刺时间以及从症状发作到再通的时间。
结果
纳入了9项研究，共1956例患者（814例接受全身麻醉，1142例接受清醒镇静）。与卒中干预期间接受清醒镇静治疗的患者相比，接受全身麻醉的患者死亡几率更高（比值比[OR]=2.59；95%置信区间[CI]，1.87-3.58），呼吸并发症几率更高（OR=2.09；95%CI，1.36-3.23），良好功能预后几率更低（OR=0.43；95%CI，0.35-0.53），血管造影成功结果几率更低（OR=0.54；95%CI，0.37-0.80）。两组之间手术时间无差异（P=0.28）。6项研究提供了干预前美国国立卫生研究院卒中量表（NIHSS）评分；在这些研究中，接受全身麻醉的患者平均NIHSS评分更高。
结论
与清醒镇静相比，接受动脉内治疗的急性缺血性卒中患者采用全身麻醉可能预后更差。然而，发病时卒中严重程度的差异可能会混淆现有研究中的比较；因此，有必要进行一项随机试验来证实这种关联。
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