CAJ | 학술논문

目的：探讨并评估全身麻醉和局部麻醉两种麻醉方式在急性脑卒中患者行动脉内介入溶栓治疗的安全性及临床疗效。方法回顾性分析该科2013年1月-2015年1月接受介入血管内溶栓治疗的急性脑卒中患者126例，随访1~6个月。对术前及术后患者临床症状的改善，临床预后及DSA图像质量等资料进行分析比较。结果126例患者中73例(58%)采用全身麻醉，53例(42%)接受局部麻醉。全身麻醉组中平均在ICU住院时间较局麻组长差异有统计学意义(6.5VS3.2 d，P<0.05)。术中并发症的发生率全身麻醉组(1/73，1.4%)较局部麻醉组(4/53，7.5%)低，差异有统计学意义(P<0.05)。在单变量及多变量的分析中，全麻组患者的住院死亡率较局麻组高，差异有统计学意义(OR=0.32，P<0.05),但全麻组的DSA图像质量、临床预后较局麻组更好，差异有统计学意义(OR=3.06，P<0.05)最终脑梗塞的面积较局麻组小，差异有统计学意义(OR=0.25，P<0.05)。结论在急性脑卒中血管内介入溶栓治疗中采用全身麻醉与局部麻醉的安全性相似，但在临床预后及DSA图像质量上全身麻醉更具优势。该研究属于回顾性分析，需通过大规模多中心实验来进一步验证。
목적：탐토병평고전신마취화국부마취량충마취방식재급성뇌졸중환자행동맥내개입용전치료적안전성급림상료효。방법회고성분석해과2013년1월-2015년1월접수개입혈관내용전치료적급성뇌졸중환자126례，수방1~6개월。대술전급술후환자림상증상적개선，림상예후급DSA도상질량등자료진행분석비교。결과126례환자중73례(58%)채용전신마취，53례(42%)접수국부마취。전신마취조중평균재ICU주원시간교국마조장차이유통계학의의(6.5VS3.2 d，P<0.05)。술중병발증적발생솔전신마취조(1/73，1.4%)교국부마취조(4/53，7.5%)저，차이유통계학의의(P<0.05)。재단변량급다변량적분석중，전마조환자적주원사망솔교국마조고，차이유통계학의의(OR=0.32，P<0.05),단전마조적DSA도상질량、림상예후교국마조경호，차이유통계학의의(OR=3.06，P<0.05)최종뇌경새적면적교국마조소，차이유통계학의의(OR=0.25，P<0.05)。결론재급성뇌졸중혈관내개입용전치료중채용전신마취여국부마취적안전성상사，단재림상예후급DSA도상질량상전신마취경구우세。해연구속우회고성분석，수통과대규모다중심실험래진일보험증。
Objective To evaluate the safety and clinical efficacy of general anesthesia (GA) and local anesthesia (LA) these two kinds of anesthesia used in intra-arterial interventional thrombolysis treatment for acute stroke patients. Methods A retrospective analysis was conducted on the 126 acute stroke patients underwent intra-arterial interventional thrombolysis treatment in our de-partment from January 2013 to January 2015. All of them were followed up for 1-6 months. The improvement in preoperative and postoperative clinical symptoms, clinical outcome and quality of DSA images and other data of the patients were analyzed and compared. Results Of the 126 patients, 73 cases (58%) adopted GA, and 53 cases (42%) used LA. GA group had longer mean length of stay in the intensive care unit than the LA group [(6.5 vs 3.2) days, P<0.05]. The incidence of intraprocedural complica-tions was lower in GA group than that in LA group[1/73 (1.4%) vs 4/53 (7.5%)], the difference was statistically significant (P<0.05). Univariate and multivariate analyses showed that, compared with LA group, GA group had higher in-hospital mortality (OR=0.32, P<0.05), but better quality of DSA images and clinical outcome (OR=3.06,P<0.05), and smaller final cerebral infarction volume (OR=0.25, P<0.05). Conclusion For acute stroke patients undergoing intra-arterial interventional thrombolysis treatment, the safety of general anesthesia is similar to that of local anesthesia, but general anesthesia is better in the aspects of clinical outcome and quality of DSA images, the view develops from this retrospective study and it needs to be verified further by larger multicenter trials.