Department of Neurology and China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China.
Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.
World Neurosurg. 2019 Oct;130:e794-e803. doi: 10.1016/j.wneu.2019.06.227. Epub 2019 Jul 9.
Postinterventional sedation is commonly used in clinical practice to ensure patient safety and comfort. Although sedation or anesthesia during thrombectomy has been well studied, the association between postinterventional sedation and functional outcomes in endovascularly treated patients with acute ischemic stroke (AIS) has yet to be investigated. We describe the association between postinterventional sedation and functional outcomes in patients with AIS treated with endovascular therapy (EVT).
This observational study was based on a prospective registry. Patients with AIS treated with EVT from January 2013 to August 2017 at Xuanwu Hospital, Capital Medical University were included. Patients receiving postinterventional sedation were compared with patients not receiving sedation. The primary outcome was the 3 months modified Rankin Scale score.
A total of 268 patients were eligible for study: 112 patients (41.8%) receiving postinterventional sedation and 156 patients (58.2%) without sedation. At 3 months follow-up, the median modified Rankin Scale score was 4 (interquartile range, 3-6) in the sedation group and 2 (interquartile range, 1-4) in the nonsedation group (P < 0.001). Multivariable regression analysis suggested that the need for postinterventional sedation was associated with unfavorable outcomes, with an odds ratio of 0.20 for functional independence (95% confidence interval [CI], 0.078-0.487; P < 0.001), 0.06 for freedom from disability (95% CI, 0.017-0.228; P < 0.001), and 8.37 for death (95% CI, 2.196-31.889; P = 0.002).
Postinterventional sedation worsens functional outcomes in patients with AIS with large-vessel occlusions treated with EVT. Whether the sedation is a causative factor or a surrogate for poor functional outcomes remains to be determined.
介入后镇静常用于临床实践，以确保患者安全和舒适。尽管取栓术中的镇静或麻醉已得到充分研究，但在接受血管内治疗的急性缺血性卒中（AIS）患者中，介入后镇静与功能结局之间的关系尚未得到研究。我们描述了接受血管内治疗（EVT）的 AIS 患者中，介入后镇静与功能结局之间的关系。
这是一项基于前瞻性登记的观察性研究。纳入 2013 年 1 月至 2017 年 8 月期间，首都医科大学宣武医院接受 EVT 治疗的 AIS 患者。将接受介入后镇静的患者与未接受镇静的患者进行比较。主要结局是 3 个月时改良 Rankin 量表评分。
共有 268 例患者符合研究条件：112 例（41.8%）接受介入后镇静，156 例（58.2%）未接受镇静。在 3 个月随访时，镇静组的中位改良 Rankin 量表评分为 4 分（四分位距，3-6），非镇静组为 2 分（四分位距，1-4）（P < 0.001）。多变量回归分析表明，介入后需要镇静与不良结局相关，功能独立的优势比为 0.20（95%置信区间，0.078-0.487；P < 0.001），无残疾的优势比为 0.06（95%置信区间，0.017-0.228；P < 0.001），死亡的优势比为 8.37（95%置信区间，2.196-31.889；P = 0.002）。
在接受 EVT 治疗的大血管闭塞性 AIS 患者中，介入后镇静会使功能结局恶化。镇静是否是功能结局不良的原因或替代因素尚待确定。
