MR CLEAN 注册研究中急性缺血性脑卒中血管内治疗期间的麻醉管理。
Anesthetic management during endovascular treatment of acute ischemic stroke in the MR CLEAN Registry.
机构信息
From the Departments of Neurology (R.-J.B.G., R.J.v.O.), Anesthesiology (W.F.F.A.B.), and Radiology (W.H.v.Z.), Cardiovascular Research Institute Maastricht, Maastricht University Medical Center; Departments of Radiology (M.L.E.B., J.M.M.) and Neurology (J.H.), Rijnstate Hospital, Arnhem; Departments of Public Health (H.F.L.), Neurology (D.W.J.D.), and Radiology (A.v.d.L., B.E.), Erasmus MC, University Medical Center, Rotterdam; Departments of Neurology (Y.B.W.E.M.R.) and Radiology and Nuclear Medicine (C.B.L.M.M., B.E.), Academic Medical Center, Amsterdam; Department of Radiology (J.A.V.), Sint Antonius Hospital, Nieuwegein; and Department of Neurology (J.B.), Haaglanden Medical Center, The Hague, the Netherlands.
出版信息
Neurology. 2020 Jan 7;94(1):e97-e106. doi: 10.1212/WNL.0000000000008674. Epub 2019 Dec 5.
OBJECTIVE
To compare outcomes after endovascular treatment (EVT) for acute ischemic stroke with 3 different types of anesthetic management in clinical practice, as anesthetic management may influence functional outcome.
METHODS
Data of patients with an anterior circulation occlusion, included in the Dutch nationwide, prospective Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) Registry between March 2014 and June 2016, were analyzed. Patients were divided into 3 groups defined by anesthetic technique performed during EVT: local anesthesia only (LA), general anesthesia (GA), or conscious sedation (CS). Primary outcome was the modified Rankin Scale score at 90 days. To compare functional outcome between groups, we estimated a common odds ratio (OR) with ordinal logistic regression, adjusted for age, sex, prestroke modified Rankin Scale score, baseline NIH Stroke Scale score, collaterals, and time from onset to arrival at intervention center.
RESULTS
A total of 1,376 patients were included. Performed anesthetic technique was LA in 821 (60%), GA in 381 (28%), and CS in 174 (13%) patients. Compared to LA, both GA and CS were associated with worse functional outcome on the modified Rankin Scale score at 90 days (GA cOR 0.75; 95% confidence interval [CI] 0.58-0.97; CS cOR 0.45; 95% CI 0.33-0.62). CS was associated with worse functional outcome than GA (cOR 0.60; 95% CI 0.42-0.87).
CONCLUSIONS
LA is associated with better functional outcome than systemic sedation in patients undergoing EVT for acute ischemic stroke. Whereas LA had a clear advantage over CS, this was less prominent compared to GA.
CLASSIFICATION OF EVIDENCE
This study provides Class III evidence that for patients with acute ischemic stroke undergoing EVT, LA improves functional outcome compared to GA or CS.
目的
比较临床实践中 3 种不同麻醉管理方式下急性缺血性脑卒中血管内治疗（EVT）的结局，因为麻醉管理可能会影响功能结局。
方法
分析 2014 年 3 月至 2016 年 6 月期间纳入荷兰全国前瞻性多中心急性缺血性脑卒中血管内治疗随机临床试验（MR CLEAN）登记的前循环闭塞患者的数据。患者根据 EVT 期间进行的麻醉技术分为 3 组：局部麻醉（LA）、全身麻醉（GA）或镇静（CS）。主要结局为 90 天时改良 Rankin 量表评分。为了比较组间功能结局，我们使用有序逻辑回归估计了共同优势比（OR），并调整了年龄、性别、基线改良 Rankin 量表评分、基线 NIH 卒中量表评分、侧支循环和发病至介入中心到达时间。
结果
共纳入 1376 例患者。LA 用于 821 例（60%），GA 用于 381 例（28%），CS 用于 174 例（13%）。与 LA 相比，GA 和 CS 与 90 天改良 Rankin 量表评分的功能结局较差相关（GA cOR 0.75；95%置信区间 [CI] 0.58-0.97；CS cOR 0.45；95% CI 0.33-0.62）。CS 与 GA 相比，功能结局更差（cOR 0.60；95% CI 0.42-0.87）。
结论
在接受急性缺血性脑卒中 EVT 的患者中，LA 与全身镇静相比，功能结局更好。虽然 LA 相对于 CS 具有明显优势，但与 GA 相比，优势不明显。
证据分类
本研究提供了 III 级证据，对于接受 EVT 的急性缺血性脑卒中患者，LA 改善功能结局优于 GA 或 CS。
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