Li Shilin, Zhang Yu, Zhang Xiaobo, Zhang Gejuan, Han Nannan, Ma Haojun, Ge Hanming, Zhao Yong, Zhang Leshi, Wang Yanfei, Shi Wenzhen, Ma Xiaojuan, Tian Yizhuo, Xiao Yixuan, Niu Yinuo, Qiao Lin, Chang Mingze
Department of Neurology, The Affiliated Hospital of Northwest University, Xi'an No.3 Hospital, Xi'an, 710069, China.
The College of Life Sciences, Northwest University, Xi'an, China.
Neurol Ther. 2023 Oct;12(5):1777-1789. doi: 10.1007/s40120-023-00528-y. Epub 2023 Aug 2.
Based on real-world case data, this study intends to explore and analyze the impact of rescue conscious sedation (CS) on the clinical outcomes of patients with anterior circulation acute ischemic stroke (AIS) receiving mechanical thrombectomy (MT).
This retrospective study enrolled patients with anterior circulation AIS who received MT and were treated with either single local anesthesia (LA) or rescue CS during MT between January 2018 and October 2021. We used univariate and multivariate logistic regression methods to compare the impact of LA and CS on the clinical outcomes of patients with AIS who received MT, including the mRS at 90 days, the incidence of poststroke pneumonia (PSP), the incidence of symptomatic intracranial cerebral hemorrhage (sICH), and the mortality rate.
We reviewed 314 patient cases with AIS who received MT. Of all patients, 164 met our search criteria. Eighty-nine patients received LA, and 75 patients received rescue CS. There was no significant difference between the two groups in the 90-day good prognosis (45.3% vs. 51.7%, p = 0.418) and mortality (17.3% vs. 22.5%, p = 0.414). Compared with the LA group, the incidence of postoperative pneumonia in the rescue CS group (44% vs. 25.8%, p = 0.015) was more significant. Multivariate stepwise logistic regression analysis revealed that intraoperative remedial CS was independently associated with PSP following MT. In a subgroup analysis, rescue CS was found to significantly increase the incidence of PSP in patients with dysphagia (OR = 7.307, 95% CI 2.144-24.906, p = 0.001). As the severity of the National Institutes of Health Stroke Scale (NIHSS) increased, intraoperative rescue CS was found to increase the risk of PSP (OR = 1.155, 95% CI 1.034-1.290, p = 0.011) by 5.1% compared to that of LA (OR = 1.104, 95% CI 1.013-1.204, p = 0.024).
Compared to LA, rescue CS during MT does not significantly improve the 90 days of good prognosis and reduce the incidence of sICH and mortality in patients with anterior circulation AIS. However, it has a significantly increased risk of poststroke pneumonia (PSP), particularly in patients with dysphagia.
基于真实世界病例数据，本研究旨在探讨和分析挽救性清醒镇静（CS）对接受机械取栓术（MT）的前循环急性缺血性卒中（AIS）患者临床结局的影响。
本回顾性研究纳入了2018年1月至2021年10月期间接受MT且在MT期间接受单纯局部麻醉（LA）或挽救性CS治疗的前循环AIS患者。我们使用单因素和多因素逻辑回归方法比较LA和CS对接受MT的AIS患者临床结局的影响，包括90天时的改良Rankin量表（mRS）、卒中后肺炎（PSP）的发生率、症状性颅内脑出血（sICH）的发生率和死亡率。
我们回顾了314例接受MT的AIS患者病例。所有患者中，164例符合我们的纳入标准。89例患者接受LA，75例患者接受挽救性CS。两组在90天良好预后（45.3%对51.7%，p = 0.418）和死亡率（17.3%对22.5%，p = 0.414）方面无显著差异。与LA组相比，挽救性CS组术后肺炎的发生率（44%对25.8%，p = 0.015）更高。多因素逐步逻辑回归分析显示，术中补救性CS与MT后PSP独立相关。在亚组分析中，发现挽救性CS显著增加了吞咽困难患者PSP的发生率（比值比[OR]=7.307，95%置信区间[CI]2.144 - 24.906，p = 0.001）。随着美国国立卫生研究院卒中量表（NIHSS）严重程度的增加，发现术中挽救性CS与LA相比，PSP风险增加5.1%（OR = 1.155，95%CI 1.034 - 1.290，p = 0.011）（LA的OR = 1.104，95%CI 1.013 - 1.204，p = 0.024）。
与LA相比，MT期间的挽救性CS并不能显著改善前循环AIS患者90天的良好预后，也不能降低sICH的发生率和死亡率。然而，它显著增加了卒中后肺炎（PSP）的风险，尤其是在吞咽困难患者中。
