麻醉对急性缺血性脑卒中后血栓切除患者血流动力学和预后的影响：回顾性分析。

IF 2 4区医学 Q3 CLINICAL NEUROLOGY

Acta neurologica Belgica Pub Date : 2023-10-19 DOI:10.1007/s13760-023-02399-4

Sofie Ordies, Thomas De Brauwer, Tom De Beule, Sven Van Poucke, Kim Bekelaar, Ben Van Bylen, Dieter Mesotten, the Stroke Consortium

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引用次数: 0

摘要

背景：血栓切除术期间的麻醉仍是一个有争议的问题。我们在一项单中心研究中回顾性研究了在全身麻醉下接受机械血栓切除术的中风患者术中血压和麻醉剂类型对3个月功能结果和死亡率的影响。方法：纳入2019年1月至2021年7月在比利时Ziekenhus Oost-Limburg-Genk接受血栓切除术的所有中风患者。已收集患者的特征和结果数据以进行基准测试。从电子麻醉记录中导出详细的围手术期数据并进行临床验证。根据围手术期低血压的存在对患者进行分层（MAP 结果：98例患者均在全麻下行机械性血栓切除术。百分之三十六（n = 35）在任何时间点都是围手术期低血压。与降压患者相比，非降压患者七氟醚的使用比例更高（73%（n = 45）对51%（n = 18），p = 0.04）。与非降压组相比，降压组围手术期使用血管升压药的比例更高（88%（n = 30）对63%（n = 39），p = 0.008）。非降压患者在3个月时功能结果良好的患者比例（mRS 0-2）高于降压患者44%（n = 27）对24%（n = 8），p 结论：与非降压患者相比，全麻下血栓切除术中任何时间出现低血压的患者可能会有更差的神经系统结果。机械血栓切除术的最佳麻醉管理需要在大型多中心研究中前瞻性地阐明。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

The effect of anesthesia on hemodynamics and outcome of patients undergoing thrombectomy after acute ischemic stroke: a retrospective analysis

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The effect of anesthesia on hemodynamics and outcome of patients undergoing thrombectomy after acute ischemic stroke: a retrospective analysis

Background

Anesthesia during thrombectomy remains a matter of debate. We retrospectively investigated the influence of intraprocedural blood pressure and type of anaesthetic agent on 3-month functional outcome and mortality in stroke patients undergoing mechanical thrombectomy under general anesthesia in a single center study.

Methods

All patients suffering from stroke who presented between January 2019 and July 2021 at Ziekenhuis Oost-Limburg Genk, Belgium and who received thrombectomy were included. Patient’s characteristics and outcome data had been collected for benchmarking. Detailed perioperative data were exported from the electronic anesthesia records and clinically validated. Patients were stratified by peri-operative presence of hypotension (MAP < 65 mmHg at any time point) versus no-hypotension (MAP ≥ 65 mmHg).

Results

All 98 patients received mechanical thrombectomy under general anesthesia. Thirty-six percent (n = 35) was hypotensive peri-operatively at any time point. Proportion of sevoflurane use was higher in non-hypotensive patients compared to hypotensive patients (73% (n = 45) vs. 51% (n = 18), p = 0.04). Peri-operative use of vasopressors was higher in the hypotensive group compared to non-hypotensive (88% (n = 30) vs. 63% (n = 39), p = 0.008). Proportion of patients with good functional outcome at 3 months (mRS 0–2) was higher in non-hypotensive patients compared to hypotensive patients 44% (n = 27) vs. 24% (n = 8), p < 0.05. 90-day mortality was lower in non-hypotensive patients compared to hypotensive patients 21% (n = 13) vs. 43% (n = 15), (p = 0.02).

Conclusion

Patients who are hypotensive at any given time during thrombectomy under general anesthesia may have worse neurological outcome compared to non-hypotensive patients. The best anaesthetic management for mechanical thrombectomy needs to be clarified prospectively in large multicenter studies.

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来源期刊

Acta neurologica Belgica 医学-临床神经学

CiteScore

4.20

自引率

3.70%

发文量

300

审稿时长

6-12 weeks

期刊介绍： Peer-reviewed and published quarterly, Acta Neurologica Belgicapresents original articles in the clinical and basic neurosciences, and also reports the proceedings and the abstracts of the scientific meetings of the different partner societies. The contents include commentaries, editorials, review articles, case reports, neuro-images of interest, book reviews and letters to the editor. Acta Neurologica Belgica is the official journal of the following national societies: Belgian Neurological Society Belgian Society for Neuroscience Belgian Society of Clinical Neurophysiology Belgian Pediatric Neurology Society Belgian Study Group of Multiple Sclerosis Belgian Stroke Council Belgian Headache Society Belgian Study Group of Neuropathology