全身麻醉而非清醒镇静可改善急性缺血性卒中血管内血栓切除术患者的功能结局：一项随机临床试验的荟萃分析和试验序贯分析
General anesthesia but not conscious sedation improves functional outcome in patients receiving endovascular thrombectomy for acute ischemic stroke: A meta-analysis of randomized clinical trials and trial sequence analysis.
作者信息
Lee Chia-Wei, Chang Yang-Pei, Huang Yen-Ta, Hsing Chung-Hsi, Pang Yu-Li, Chuang Min-Hsiang, Wu Su-Zhen, Sun Cheuk-Kwan, Hung Kuo-Chuan
机构信息
Department of Neurology, Chi Mei Medical Center, Tainan City, Taiwan.
Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan.
出版信息
Front Neurol. 2022 Sep 14;13:1017098. doi: 10.3389/fneur.2022.1017098. eCollection 2022.
BACKGROUND
This study aimed at comparing the difference in prognostic outcomes between patients receiving general anesthesia (GA) and conscious sedation (CS) for endovascular thrombectomy after acute ischemic stroke.
METHODS
Databases from Medline, Embase, Google scholar, and Cochrane library were searched for randomized controlled studies (RCTs) comparing patients undergoing GA and CS for endovascular thrombectomy following anterior circulation ischemic stroke. The primary outcome was frequency of 90-day good functional outcome [defined as modified Rankin Scale score of ≤ 2], while secondary outcomes included successful recanalization rate (SRR) [i.e., modified thrombolysis in cerebral infarction = 2b or 3], mortality risk, symptomatic intracranial hemorrhage (ICH), procedure-related complications, hypotension, pneumonia, neurological outcome at post-procedure 24-48 h, and puncture-to-recanalization time.
RESULTS
Six RCTs including 883 patients published between 2016 and 2022 were included. Merged results revealed a higher SRR [risk ratio (RR) = 1.11, 95% CI: 1.03-1.2, = 0.007; = 29%] and favorable neurological outcomes at 3-months (RR = 1.2, 95% CI: 1.01-1.41, = 0.04; = 8%) in the GA group compared to CS group, without difference in the risk of mortality (RR = 0.88), symptomatic ICH (RR = 0.91), procedure-related complications (RR = 1.05), and pneumonia (RR = 1.9) as well as post-procedure neurological outcome (MD = -0.21) and successful recanalization time (MD = 3.33 min). However, GA was associated with a higher risk of hypotension compared with that of CS.
CONCLUSION
Patients with acute anterior circulation ischemic stroke receiving GA were associated with a higher successful recanalization rate as well as a better 3-month neurological outcome compared to the use of CS. Further investigations are warranted to verify our findings.
SYSTEMATIC REVIEW REGISTRATION
www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022342483, identifier: CRD42022342483.
背景
本研究旨在比较急性缺血性卒中后接受全身麻醉（GA）和清醒镇静（CS）进行血管内血栓切除术的患者预后结果的差异。
方法
检索Medline、Embase、谷歌学术和Cochrane图书馆数据库，查找比较前循环缺血性卒中后接受GA和CS进行血管内血栓切除术患者的随机对照试验（RCT）。主要结局是90天良好功能结局的发生率[定义为改良Rankin量表评分≤2]，次要结局包括成功再通率（SRR）[即脑梗死改良溶栓分级为2b或3级]、死亡风险、症状性颅内出血（ICH）、手术相关并发症、低血压、肺炎、术后24 - 48小时的神经功能结局以及穿刺至再通时间。
结果
纳入了2016年至2022年间发表的6项RCT，共883例患者。汇总结果显示，与CS组相比，GA组的SRR更高[风险比（RR）= 1.11，95%置信区间：1.03 - 1.2，P = 0.007；I² = 29%]，且3个月时神经功能结局良好（RR = 1.2，95%置信区间：1.01 - 1.41，P = 0.04；I² = 8%），而在死亡风险（RR = 0.88）、症状性ICH（RR = 0.91）、手术相关并发症（RR = 1.05）、肺炎（RR = 1.9）以及术后神经功能结局（MD = -0.21）和成功再通时间（MD = 3.33分钟）方面无差异。然而，与CS相比，GA与更高的低血压风险相关。
结论
与使用CS相比，急性前循环缺血性卒中患者接受GA时具有更高的成功再通率以及更好的3个月神经功能结局。需要进一步研究以验证我们的发现。
系统评价注册
www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022342483，标识符：CRD42022342483。
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