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首页> 外文期刊>Journal of neurosurgical anesthesiology >Hemodynamic Management of Patients During Endovascular Treatment of Acute Ischemic Stroke Under Conscious Sedation: A Retrospective Cohort Study
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Hemodynamic Management of Patients During Endovascular Treatment of Acute Ischemic Stroke Under Conscious Sedation: A Retrospective Cohort Study

机译：有意识地区急性缺血性脑卒中血管内治疗患者的血流动力学管理：回顾性队列研究

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Background: Anesthetic modality and hemodynamic management during mechanical thrombectomy (MT) for acute ischemic stroke (AIS) are potential contributors to the success of revascularization. The aims of our study were to review the hemodynamic management by anesthesiologists and clinical outcomes in patients undergoing MT under conscious sedation. Methods: Retrospective cohort study of patients with anterior circulation AIS from January 2012 to March 2016. Primary outcome was hemodynamic intervention, defined as administration of vasoactive drugs to maintain systolic blood pressure (BP) between 140 and 180 mm Hg. The secondary outcome was poor hemodynamic control, defined as BP outside target for >15 minutes despite hemodynamic intervention. We performed regression analysis to determine the predictors of hemodynamic intervention and poor hemodynamic control. Results: A total of 126 patients were included in this study; 92% (116) receiving conscious sedation and 8% (10) no sedation. Upon arrival to the neuroradiology suite, systolic BP was 180 mm Hg in 14.3%. Hemodynamic intervention was required in 38.9% of patients; 15.1% for hypotension and 19.8% for hypertension. In the multivariate analysis, systolic BP on hospital admission (odds ratio, 1.02; 95% confidence interval, 1.00-1.04; P=0.019) constituted a predictor for hemodynamic intervention. Poor hemodynamic control occurred in 12.7% of patients, with lower baseline systolic BP being associated with higher risk of intraprocedural hypotension (odds ratio, 0.92; 95% confidence interval, 0.89-0.96; P<0.001). In-hospital mortality was 13.6%. Conclusions: Hemodynamic intervention is frequent during MT under conscious sedation. The routine presence of anesthesiologists during MT may be helpful in maintaining hemodynamic stability and allow rapid treatment of emergent complications. An individualized approach with tailored hemodynamic targets is required during management of patients undergoing MT for AIS.
机译：背景：急性缺血性卒中（AIS）机械血栓切除术期间的麻醉模态和血流动力学管理是血运重建成功的潜在贡献者。我们的研究目的是通过有意识地区镇静的患者进行麻醉学家和临床结果来审查血流动力学管理。方法：2012年1月至2016年3月前循环AIS患者的回顾性队列研究。主要结果是血流动力学干预，定义为血管活性药物的施用，以维持140-180mm Hg之间的收缩压（BP）。次级结果是血液动力学控制差，尽管血液动力学干预，但仍然是> 15分钟外的BP。我们进行了回归分析以确定血流动力学干预的预测因子和血液动力学控制不良。结果：本研究共纳入126名患者; 92％（116）接受有意识的镇静和8％（10）没有镇静。到达神经内脏套件后，收缩性BP为180毫米Hg，14.3％。 38.9％的患者需要血流动力学干预;高血压的15.1％和19.8％的高血压。在多变量分析中，收缩期BP入院（差距为1.02; 95％置信区间，1.00-1.04; P = 0.019）构成了血液动力学干预的预测因子。在12.7％的患者中发生差的血液动力学控制，较低的基线收缩型BP与较高的颅腺间低血压风险较高（差距，0.92; 95％置信区间，0.89-0.96; P <0.001）。住院医院死亡率为13.6％。结论：在有意识的镇静下MT期间血流动力学干预频繁。 MT期间麻醉药剂的常规存在可能有助于保持血流动力学稳定性并允许快速治疗紧急并发症。在治疗AIS的患者的管理期间需要一种具有量身定制血液动力学靶标的个性化方法。

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