TY - JOUR T1 -全麻与非ga在缺血性脑卒中血管内取栓中的比较:随机对照试验的系统回顾和荟萃分析首页Sp - 10.1212/ wnl.0000000000207066AU - Douglas Campbell AU - Elise Butler AU - Ruby Blythe Campbell AU - Jess Ho AU - P. Alan Barber Y1 - 2023/02/16 UR - http://n.首页neurology.org/content/early/2023/02/16/WNL.0000000000207066.abstract N2 -背景和目的大血管闭塞缺血性卒中的血管内取栓术(EVT)可以在全身麻醉(GA)下进行，也可以单独使用非全身麻醉技术，如有意识镇静(CS)或局部麻醉(LA)。先前的小型荟萃分析表明，与非GA技术相比，GA技术具有更高的再通率和更好的功能恢复。进一步rct的发表可以为选择GA技术和非GA技术提供最新的指导。方法在Medline、Embase和Cochrane中央对照试验登记系统检索了卒中EVT患者随机分为GA或非GA的试验。采用随机效应模型进行系统回顾和元分析。结果系统评价和meta分析共纳入7项rct。这些试验共包括980名参与者(GA, N=487;non-GA, N = 493)。GA可使再通率提高9.0% (GA 84.6%，非GA 75.6%; OR=1.75, 95% CI 1.26 to 2.42, P=0.0009) and the proportion of patients with functional recovery improves by 8.4% (GA 44.6 % versus non-GA 36.2%; OR=1.43, 95% CI 1.04 to 1.98, P=0.03). There was no difference in hemorrhagic complications or 3 month mortality.ConclusionsIn ischemic stroke patients treated with EVT, general anesthesia (GA) is associated with higher recanalization rates and improved functional recovery at 3 months compared with non-GA techniques. Conversion to GA and subsequent intention to treat analysis will underestimate the true therapeutic benefit. GA is established as effective in improving recanalization rates in EVT (7 Class 1 studies) with a high GRADE certainty rating. GA is established as effective in improving functional recovery at 3 months in EVT (5 Class 1 studies) with a moderate GRADE certainty rating. Stroke services need to develop pathways to incorporate GA as the first choice for most endovascular thrombectomy procedures in acute ischemic stroke with a level A recommendation for recanalization and level B recommendation for functional recovery. ER -