全身麻醉与镇静，均行血流动力学控制，用于急性缺血性脑卒中的动脉内治疗：GASS 随机试验。

General Anesthesia versus Sedation, Both with Hemodynamic Control, during Intraarterial Treatment for Stroke: The GASS Randomized Trial.

机构信息

From the Anesthesia and Intensive Care Department, Center of Clinical Investigation, Inserm, Rennes Teaching Hospital, Rennes, France.

University Rennes; the Radiology Department, Center of Clinical Investigation, Inserm, Rennes Teaching Hospital, Rennes, France.

出版信息

Anesthesiology. 2022 Apr 1;136(4):567-576. doi: 10.1097/ALN.0000000000004142.

DOI:10.1097/ALN.0000000000004142

PMID:35226737

Abstract

BACKGROUND

It is speculated that the anesthetic strategy during endovascular therapy for stroke may have an impact on the outcome of the patients. The authors hypothesized that conscious sedation is associated with a better functional outcome 3 months after endovascular therapy for the treatment of stroke compared with general anesthesia.

METHODS

In this single-blind, randomized trial, patients received either a standardized general anesthesia or a standardized conscious sedation. Blood pressure control was also standardized in both groups. The primary outcome measure was a modified Rankin score less than or equal to 2 (0 = no symptoms; 5 = severe disability) assessed 3 months after treatment. The main secondary outcomes were complications, mortality, reperfusion results, and National Institutes of Health Stroke Scores at days 1 and 7.

RESULTS

Of 351 randomized patients, 345 were included in the analysis. The primary outcome occurred in 129 of 341 (38%) of the patients: 63 (36%) in the conscious sedation group and 66 (40%) in the general anesthesia group (relative risk, 0.91 [95% CI, 0.69 to 1.19]; P = 0.474). Patients in the general anesthesia group experienced more intraoperative hypo- or hypertensive episodes, while the cumulative duration was not different (mean ± SD, 36 ± 31 vs. 39 ± 25 min; P = 0.079). The time from onset and from arrival to puncture were longer in the general anesthesia group (mean difference, 19 min [i.e., -00:19] [95% CI, -0:38 to 0] and mean difference, 9 min [95% CI, -0:18 to -0:01], respectively), while the time from onset to recanalization was similar in both groups. Recanalization was more often successful in the general anesthesia group (144 of 169 [85%] vs. 131 of 174 [75%]; P = 0.021). The incidence of symptomatic intracranial hemorrhage was similar in both groups.

CONCLUSIONS

The functional outcomes 3 months after endovascular treatment for stroke were similar with general anesthesia and sedation. Our results, therefore, suggest that clinicians can use either approach.

摘要

背景

据推测，血管内治疗中风的麻醉策略可能会对患者的预后产生影响。作者假设，与全身麻醉相比，在血管内治疗中风的过程中，接受镇静的患者在治疗后 3 个月的功能结局更好。

方法

在这项单盲、随机试验中，患者接受标准化全身麻醉或标准化镇静。两组的血压控制也标准化。主要结局测量是治疗后 3 个月时改良 Rankin 评分≤2 分（0=无症状；5=严重残疾）。主要次要结局是并发症、死亡率、再灌注结果和第 1 天及第 7 天的国立卫生研究院卒中量表评分。

结果

在 351 名随机患者中，345 名患者纳入分析。主要结局发生在 341 名患者中的 129 名（38%）：镇静组 63 名（36%）和全身麻醉组 66 名（40%）（相对风险，0.91[95%置信区间，0.69 至 1.19]；P=0.474）。全身麻醉组患者术中出现更多的低血压或高血压发作，但累计时间无差异（均值±标准差，36±31 比 39±25 分钟；P=0.079）。全身麻醉组患者的发病至穿刺时间和发病至到达时间较长（平均差值，19 分钟[即-00:19][95%置信区间，-0:38 至 0]和平均差值，9 分钟[95%置信区间，-0:18 至 -0:01]），而两组的发病至再通时间相似。全身麻醉组再通更常见（169 例中的 144 例[85%]比 174 例中的 131 例[75%]；P=0.021）。两组症状性颅内出血的发生率相似。