目的 探讨全身麻醉与清醒镇静麻醉对急性基底动脉闭塞血管内治疗患者早期神经功能预后的影响。方法 回顾性分析2018-05至2025-04北京天坛医院接受血管内治疗的178例急性基底动脉闭塞(BAO)的患者临床资料。根据麻醉方式分为全身麻醉组(n=139)和清醒镇静麻醉组(n=39)。记录两组患者术前及术后24 h美国国立卫生研究院卒中量表(NIHSS)评分。采用单因素分析筛选变量,并进行多因素Logistic回归分析,对比不同麻醉方式对BAO血管内治疗患者术后早期神经功能的影响。结果 全身麻醉组和清醒镇静麻醉组在年龄、性别、脑血管高危因素、发病方式、术前实验室检查、闭塞部位、卒中类型上差异无统计学意义。与清醒镇静麻醉组相比,全身麻醉组术前NIHSS评分[22(11,35)vs. 16(6,30)]及术后24 h NIHSS评分[17(16,20)vs. 9(8,14)]更高,术中支架取栓使用率、动脉内替罗非班使用率和术中血管成形操作率更高,麻醉持续时间更长,差异均有统计学意义(P<0.05)。多因素分析提示两组早期神经功能改善存在统计学差异(OR=0.31;95%CI:0.11~0.84;P=0.02)。结论 麻醉方式是BAO血管内治疗患者早期神经功能预后独立影响因素,全身麻醉与较差的术后早期神经功能预后相关。
Abstract
Objective To investigate the effects of general anesthesia and conscious sedation anesthesia on the early neurological prognosis of patients with acute basilar artery occlusion (BAO) treated by endovascular therapy. Methods The clinical data of 178 patients with acute BAO who received endovascular therapy in Beijing Tiantan Hospital from May 2018 to April 2024 were retrospectively analyzed. The patients were divided into a general anesthesia group (n=139) and a conscious sedation anesthesia group (n=39). National Institutes of Health Stroke Scale (NIHSS) scores of the two groups were recorded before and 24 hours after surgery. Univariate analysis was performed to screen variables, followed by multivariable logistic regression to explore the effects of different anesthesia methods on the early neurological function of the patients. Results There was no statistically significant difference between the two groups in age, gender, cerebrovascular high-risk factors, onset mode, preoperative laboratory tests, occlusion site, and stroke type. Compared with the conscious sedation anesthesia group, the preoperative NIHSS score of the general anesthesia group [22 (11,35) vs. 16 (6,30)] and the postoperative 24-hour NIHSS score [17 (16,20) vs. 9(8,14)] were higher, the intraoperative stent thrombectomy rate, the intra-arterial tirofiban use rate and intraoperative angioplasty operation rate were higher, and the duration of anesthesia was longer, and all differences were statistically significant (P<0.05). Multivariate analysis showed that there was a statistically significant difference in early neurological improvement between the two groups (OR=0.31; 95%CI: 0.11-0.84; P=0.02). Conclusions Anesthesia method is an independent factor influencing the early neurological prognosis of patients with acute BAO treated by endovascular therapy, and general anesthesia is associated with poorer early neurological prognosis.
关键词
麻醉 /
基底动脉闭塞 /
血管内治疗 /
早期神经功能 /
预后
Key words
anesthesia /
basilar artery occlusion /
endovascular therapy /
early neurological function /
prognosis
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参考文献
[1] Liang F, Wu Y, Wang X, et al. General anesthesia vs conscious sedation for endovascular treatment in patients with posterior circulation acute ischemic stroke: an exploratory randomized clinical trial[J]. JAMA Neurol, 2023, 80(1): 64-72.
[2] Alemseged F, Nguyen T N, Alverne F M, et al. Endovascular therapy for basilar artery occlusion[J]. Stroke, 2023, 54(4): 1127-1137.
[3] Du H, Tong X, Sun X, et al. Effect of anesthesia strategy during endovascular therapy on 90-day outcomes in acute basilar artery occlusion: a retrospective observational study[J]. BMC Neurol, 2020, 20(1): 398.
[4] 陈舜杨, 陈炜越, 林桂涵, 等. 计算机断层扫描灌注成像对经血管内治疗的基底动脉闭塞患者预后的预测价值[J]. 温州医科大学学报, 2025, 55(7): 565-572.
[5] Liu H, He Y, Zhou T, et al. Evaluation of using a double helical, closed-cell stent-retriever (Skyflow) for thrombectomy procedures in acute arterial occlusion: A preclinical study and a clinical trial[J]. J Interv Med, 2022, 5(4): 190-195.
[6] 徐亚辉, 罗 彬, 白 晋, 等. 急性缺血性脑卒中介入取栓治疗的预后及其影响因素[J]. 武警医学, 2022, 33(2): 115-118,124.
[7] van Houwelingen R C, Luijckx G J, Mazuri A, et al. Safety and outcome of intra-arterial treatment for basilar artery occlusion[J]. JAMA Neurol, 2016, 73(10): 1225-1230.
[8] 侯贝贝, 查明明, 朱玉娟, 等. 急性基底动脉闭塞性脑卒中早期血管内治疗预后的影响因素分析[J]. 介入放射学杂志, 2023, 32(9): 899-904.
[9] 林晓东, 郭 雨. 不同麻醉方式下行血管内治疗对急性基底动脉闭塞性脑梗死患者预后的影响[J]. 中国保健营养, 2021, 31(5): 114.
[10] Skutecki J, Audibert G, Finitsis S, et al. General anesthesia or conscious sedation for endovascular therapy of basilar artery occlusions: ETIS registry results[J]. Rev Neurol (Paris), 2022, 178(8): 771-779.
[11] Schönenberger S, Uhlmann L, Hacke W, et al. Effect of conscious sedation vs general anesthesia on early neurological improvement among patients with ischemic stroke undergoing endovascular thrombectomy: a randomized clinical trial[J]. JAMA, 2016, 316(19): 1986-1996.
[12] 路昭颖, 贺婵婵, 李宝宝, 等. 急性缺血性脑卒中患者机械取栓术预后影响因素的研究进展[J]. 中国临床研究, 2023, 36(3): 375-379.
[13] Girot J B, Richard S, Gariel F, et al. Predictors of unexplained early neurological deterioration after endovascular treatment for acute ischemic stroke[J]. Stroke, 2020, 51(10): 2943-2950.
[14] Chen P R, Artime C A, Sheth S A, et al. Sedation vs general anesthesia for endovascular therapy in acute ischemic stroke: the SEGA randomized clinical Trial[J]. JAMA Neurol, 2025, 82(12): 1265-1273.
[15] Giacoppo D. Untangling the knot of the best endovascular treatment for femoropopliteal artery disease[J]. Int J Cardiol, 2024, 407: 132108.
[16] Fan B, Qiu L Q, Zhang L C, et al. General anesthesia vs. conscious sedation and local anesthesia for endovascular treatment in patients with posterior circulation acute ischemic stroke: An updated systematic review and meta-analysis[J]. J Stroke Cerebrovasc Dis, 2024, 33(1): 107471.
[17] 向远阳, 张保朝, 高 军, 等. 不同病理机制急性椎基底动脉闭塞患者临床特征及血管内治疗效果比较[J]. 实用心脑肺血管病杂志, 2022, 30(6): 60-64.
[18] Tao C, Nogueira R G, Zhu Y, et al. Trial of endovascular treatment of acute basilar-artery occlusion[J]. N Engl J Med, 2022, 387(15): 1361-1372.
[19] Maïer B, Finitsis S, Mazighi M, et al. Thrombectomy with or without intravenous thrombolytics in basilar artery occlusion[J]. Ann Neurol, 2023, 94(3): 596-604.
[20] Weber R, Minnerup J, Nordmeyer H, et al. Thrombectomy in posterior circulation stroke: differences in procedures and outcome compared to anterior circulation stroke in the prospective multicentre REVASK registry[J]. Eur J Neurol, 2019, 26(2): 299-305.
[21] Li L, Lv J, Han J J, et al. Nomogram model of functional outcome for endovascular treatment in patients with acute basilar artery occlusion[J]. Front Neurol, 2023, 14: 1277189.
[22] Xiao Y, Zhang X, Yi T, et al. Effectiveness of Endovascular treatment for acute mild basilar artery occlusion stroke: a multicenter real-world study[J]. Stroke, 2025, 56(11): 3187-3198.
[23] Gupta D, D’Anna L, Klein P, et al. Endovascular treatment for basilar artery occlusion[J]. J Clin Med, 2024, 13(14): 4153.
[24] Tao C, Yuan G, Xu P, et al. Anesthetic management and outcomes of endovascular treatment of basilar artery occlusion: results from the attention registry[J]. J Stroke, 2023, 25(3): 399-408.
[25] 石万达, 白雪松, 孔文程, 等. 发病超24 h急性缺血性卒中机械取栓的研究进展[J]. 中国脑血管病杂志, 2024, 21(5): 349-354.
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