椎动脉基底动脉卒中血管内治疗期间全身麻醉与监护麻醉的比较。
General anesthesia versus monitored anesthesia care during endovascular therapy for vertebrobasilar stroke.
作者信息
Hu Guangjun, Shi Zhen, Li Bixi, Shao Weidong, Xu Bo
机构信息
The First Clinical College of Southern Medical University Guangzhou, Guangdong Province, China.
Department of Anesthesiology, General Hospital of The Southern Theater Command of The Chinese PLA Guangzhou, Guangdong Province, China.
出版信息
Am J Transl Res. 2021 Mar 15;13(3):1558-1567. eCollection 2021.
OBJECTIVE
The objective is to compare the effect of general anesthesia (GA) and monitored anesthesia care (MAC) on clinical outcomes in patients with endovascular therapy for vertebrobasilar occlusion stroke.
METHODS
139 patients undergoing endovascular therapy for vertebrobasilar stroke, were recruited. The patients were randomized into GA group and MAC group (about 1:1 ratio). GA group received general anesthesia and MAC group received monitored anesthesia care during endovascular therapy. The primary outcome measure was the shift in the degree of disability among the 2 groups as measured by the modified Rankin scale score (mRS) at 90 days (80-100 days). Secondary end points included infarct volume and related complications.
RESULTS
The patients were assigned randomly (about 1:1 allocation) to GA group (n=72) and MAC group (n=67). The primary outcome of functional independence measured by 90-day mRS score was not significantly different between the 2 groups (median (IQR), 2 (1-3) vs. 3 (1-4); P=0.316). Final infarct volume was smaller in the GA group than in the MAC group (median (IQR), 27.60 (13.75-83.52) vs. 33.60 (26.85-92.95); P=0.045). There were no differences with statistical significance in rates of successful reperfusion (modified Thrombolysis in Cerebral Ischemia (mTICI) 2b-3) between 2 groups (73.61% vs. 76.12%; P=0.734). Early neurological outcomes measured by the 24-hour National Institutes of Health Stroke Scale scores (NIHSS) showed that 11 (interquartile range (IQR), 3-22) in GA group and 11 (interquartile range (IQR), 7-25) in MAC group, but were not statistically significant. There was no statistical difference in postoperative complications between the two groups.
CONCLUSION
For patients who underwent endovascular therapy for vertebrobasilar occlusion strok caused by occlusions in the posterior circulation, MAC appears to be as effective as GA. However, MAC is associated with bigger final infarct volume. Future studies are warranted to confirm our findings.
目的
比较全身麻醉（GA）和监护下麻醉（MAC）对椎基底动脉闭塞性卒中血管内治疗患者临床结局的影响。
方法
招募139例接受椎基底动脉卒中血管内治疗的患者。患者被随机分为GA组和MAC组（比例约为1:1）。GA组在血管内治疗期间接受全身麻醉，MAC组接受监护下麻醉。主要结局指标是90天（80 - 100天）时通过改良Rankin量表评分（mRS）测量的两组残疾程度变化。次要终点包括梗死体积和相关并发症。
结果
患者被随机（约1:1分配）分为GA组（n = 72）和MAC组（n = 67）。两组间以90天mRS评分衡量的功能独立性主要结局无显著差异（中位数（四分位间距），2（1 - 3）对3（1 - 4）；P = 0.316）。GA组的最终梗死体积小于MAC组（中位数（四分位间距），27.60（13.75 - 83.52）对33.60（26.85 - 92.95）；P = 0.045）。两组间成功再灌注率（改良脑缺血溶栓（mTICI）2b - 3）无统计学差异（73.61%对76.12%；P = 0.734）。以24小时美国国立卫生研究院卒中量表评分（NIHSS）衡量的早期神经学结局显示，GA组为11（四分位间距（IQR），3 - 22），MAC组为11（四分位间距（IQR），7 - 25），但无统计学意义。两组术后并发症无统计学差异。
结论
对于后循环闭塞所致椎基底动脉闭塞性卒中接受血管内治疗的患者，MAC似乎与GA一样有效。然而，MAC与更大的最终梗死体积相关。未来研究有必要证实我们的发现。
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