麻醉方式对不配合的急性颅内前循环闭塞病人机械取栓术的影响

目的探讨全身麻醉(GA)与镇静麻醉(SA)对不合作的急性颅内前循环闭塞机械取栓术的影响。方法回顾性分析2017年1月至2019年5月收治的41例急性颅内前循环闭塞的临床资料。接受静脉溶栓桥血管内治疗或直接血管内治疗,但病人因躁动、失语、谵妄等不能配合治疗,其中21例采用GA(GA组例),20例采用SA(SA组)。结果两组穿刺至再通时间、入院至再通时间、取栓次数、血管再通率、术后7 d NIHSS评分、症状性颅内出血率、病死率均无明显差异(P>0.05)。GA组1次再通率、发病90 d预后良好率均明显高于SA组(P<0.05)。结论对于急性颅内前循环大血管闭塞,如果病人不能配合机械取栓术,相比SA,GA可提高1次再通率,有利于远期神经功能恢复,而且安全性相似。

Effect of anesthesia on mechanical thrombectomy in uncooperative patients with acute anterior circulation occlusion

Objective To explore the effects of general anesthesia (GA) and sedation anesthesia (SA) on mechanical thrombectomy in uncooperative patients with acute anterior circulation occlusion. Methods The clinical data of 41 patients with acute anterior circulation occlusion who were admitted to our hospital from January 2017 to May 2019 were retrospectively analyzed. The patients received intravenous thrombolysis bridge intravascular treatment or direct intravascular treatment, but the patients could not cooperate with the treatment due to agitation, aphasia, delirium, etc. Of these 41 patients, 21 patients received GA (GA group) and 20 patients received SA (SA group). Results There was no significant difference in the time from puncture to recanalization, the time from admission to recanalization, the number of thrombectomy, the rate of vascular recanalization, the NIHSS score 7 days after the operation, the rate of symptomatic intracranial hemorrhage, and the mortality between the two groups (P>0.05). The recanalization rate of one operation and the rate of good prognosis at 90 days in the GA group were significantly higher than those in the SA group (P<0.05). Conclusion If the patient with acute anterior circulation occlusion can not cooperate with mechanical thrombectomy, the GA can increase the recanalization rate compared with the SA, which is helpful to the long-term neural function recovery. The safety is similar between the GA and the SA