Anesthesia Technique and Outcomes of Mechanical Thrombectomy in Patients With Acute Ischemic Stroke.
Anesthesia Technique and Outcomes of Mechanical Thrombectomy in Patients With Acute Ischemic Stroke.
复制标题
急性缺血性中风患者的麻醉技术和机械血栓切除术的结局。
DOI：
10.1161/strokeaha.116.015343
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发表时间：
2017-02
期刊：
影响因子：
8.3
通讯作者：
Jabbour P
中科院分区：
文献类型：
--
作者：
Bekelis K;Missios S;MacKenzie TA;Tjoumakaris S;Jabbour P
麻醉技术对急性缺血性卒中机械血栓切除术结局的影响仍然是一个有争议的问题。我们研究了全身麻醉与缺血性卒中患者接受机械血栓切除术的结局之间的关系。我们对2009-2013年因缺血性卒中接受机械血栓切除术的患者进行了一项队列研究，这些患者在纽约州规划和研究合作系统（SPARCS）数据库中登记。使用工具变量（全身麻醉住院率）分析来模拟随机化的影响，并研究麻醉技术与病死率和住院时间（LOS）的相关性。在1,174例患者中，441例（37.6%）接受了全身麻醉，733例（62.4%）接受了清醒镇静。采用工具变量分析，我们发现与清醒镇静相比，全身麻醉与6.4%的病死率增加（95%CI，1.9%至11.0%）和8.4天的LOS延长（95%CI，2.9至14.0）相关。这相当于15名患者需要接受清醒镇静治疗，以防止1人死亡。我们的研究结果在混合效应回归和倾向评分调整回归模型的敏感性分析中是稳健的。通过对纽约州接受机械血栓切除术的急性缺血性卒中患者进行全面的全付费队列研究，我们发现全身麻醉与病死率和LOS增加相关。在标准化急性卒中护理时应考虑这些因素。
The impact of anesthesia technique on the outcomes of mechanical thrombectomy for acute ischemic stroke remains an issue of debate. We investigated the association of general anesthesia with outcomes in patients undergoing mechanical thrombectomy for ischemic stroke. We performed a cohort study involving patients undergoing mechanical thrombectomy for ischemic stroke from 2009-2013, who were registered in the New York Statewide Planning and Research Cooperative System (SPARCS) database. An instrumental variable (hospital rate of general anesthesia) analysis was used to simulate the effects of randomization and investigate the association of anesthesia technique with case-fatality and length of stay (LOS). Among 1,174 patients, 441 (37.6%) underwent general anesthesia, and 733 (62.4%) underwent conscious sedation. Employing an instrumental variable analysis, we identified that general anesthesia was associated with a 6.4% increased case-fatality (95% CI, 1.9% to 11.0%), and 8.4 days longer LOS (95% CI, 2.9 to 14.0) in comparison to conscious sedation. This corresponded to 15 patients needing to be treated with conscious sedation to prevent one death. Our results were robust in sensitivity analysis with mixed effects regression, and propensity score adjusted regression models. Using a comprehensive all-payer cohort of acute ischemic stroke patients undergoing mechanical thrombectomy in New York State, we identified an association of general anesthesia with increased case fatality and LOS. These considerations should be taken into account when standardizing acute stroke care.