全身麻醉与非全身麻醉在椎基底动脉卒中血管内治疗中的比较

贵州医科大学   麻醉与心脏电生理课题组

翻译:柏雪   编辑：张中伟   审校：曹莹

背景：急性椎基底动脉闭塞(VBAO)治疗时的最佳麻醉方式仍有争议。我们旨在评估麻醉方式及管理对接受血管内治疗(EVT)的VBAO患者结局的影响。

方法:纳入21个在中国脑卒中中心接受EVT治疗的急性VBAO患者，对其进行回顾性分析，比较全麻组和非全麻组对治疗的影响。主要结果为有利结果，定义为90天的改良Rankin量表(mRS)评分0-3分。次要结果包括功能独立性(90天mRS评分0-2)和再灌注成功率。安全性结果包括90天的全因死亡率、手术并发症的发生率以及症状性颅内出血(sICH)的发生率。此外，我们对由格拉斯哥昏迷量表 (GCS) 评分（≤8 或 >8）定义的亚组结果也进行了分析。

结果：在倾向评分匹配队列中，两组患者的主要结果、次要结果和安全性结果均无差异。但GCS评分低于8分的患者中，GA组再灌注成功比例明显高于非GA组(aOR, 3.57, 95% CI 1.06-12.50, p = 0.04)。在治疗权重-倾向得分调整队列的逆概率中，也发现了类似的结果。

结论：在EVT治疗时，使用GA的患者与非GA的效果一致。但对于GCS评分较差(≤8分)的患者，GA的患者再灌注成功率更高。

原始文献来源：Yanan Lu, Pengfei Xu, Jinjing Wang, et, al. General anesthesia vs. non-general anesthesia for vertebrobasilar stroke endovascular therapy, Frontiers in Neurology,  Pub Date : 2023-02-02 , DOI: 10.3389/fneur.2023.1104487

英文原文：

General anesthesia vs. non-general anesthesia for vertebrobasilar stroke endovascular therapy

Background: The optimal type of anesthesia for acute vertebrobasilar artery occlusion (VBAO) remains controversial. We aimed to assess the influence of anesthetic management on the outcomes in VBAO patients received endovascular treatment (EVT).

Methods: Patients underwent EVT for acute VBAO at 21 stroke centers in China were retrospectively enrolled and compared between the general anesthesia (GA) group and non-GA group. The primary outcome was the favorable outcome, defined as a modified Rankin Scale (mRS) score 0–3 at 90 days. Secondary outcomes included functional independence (90-day mRS score 0–2), and the rate of successful reperfusion. The safety outcomes included all-cause mortality at 90 days, the occurrence of any procedural complication, and the rate of symptomatic intracranial hemorrhage (sICH). In addition, we performed analyses of the outcomes in subgroups that were defined by Glasgow Coma Scale (GCS) score (≤8 or >8).

Results: In the propensity score matched cohort, there were no difference in the primary outcome, secondary outcomes and safety outcomes between the two groups. Among patients with a GCS score of 8 or less, the proportion of successful reperfusion was significantly higher in the GA group than the non-GA group (aOR, 3.57, 95% CI 1.06–12.50, p = 0.04). In the inverse probability of treatment weighting-propensity score-adjusted cohort, similar results were found.

Conclusions: Patients placed under GA during EVT for VBAO appear to be as effective and safe as non-GA. Furthermore, GA might yield better successful reperfusion for worse presenting GCS score (≤8).