摘要
Abstract
Objective To construct a predictive scale for emergency conversion to general anesthesia during mechanical thrombectomy(MT)in patients with acute ischemic stroke(AIS).
Methods Patients with AIS who received MT at the First Affiliated Hospital with Nanjing Medical University from January 2020 to December 2023 were retrospectively included.They were categorized into two groups based on the anesthesia approach:the local anesthesia/monitored anesthesia care(LA/MAC)group and the emergency conversion to general anesthesia group.Multivariate logistic regression analysis was performed to determine the risk factors for emergency conversion to general anesthesia during MT.The scores were assigned to each risk factor based on the results of multivariate logistic regression analysis,and the predictive scale was subsequently developed.
Results A total of 864 patients with AIS were included,including 803 patients(92.9%)in the LA/MAC group and 61 patients(7.1%)in the emergency conversion to general anesthesia group.Multivariate logistic regression analysis showed that NIHSS score≥15 points(OR1.53,95%CI 1.27-1.78),ASPECTS<6 points(OR1.40,95%CI1.21-1.70),aphasia(OR1.62,95%CI 1.30-1.91),and vertebrobasilar artery occlusion(OR2.21,95%CI1.82-2.96)were independently associated with emergency conversion to general anesthesia during MT.Based on the above four independent risk factors,an emergency conversion to general anesthesia predictive scale was developed[NIHSS score≥15 points(1 point),ASPECTS<6 points(1 point),aphasia(1 point),and vertebrobasilar artery occlusion(2 points)].The optimal cutoffvalue of the scale for predicting emergency conversion to general anesthesia in AIS patients receiving MT was 3 points.When the scale score was≥3 points,the AUC was 0.853,and the sensitivity,the specificity,and the negative predictive value for predicting emergency conversion to general anesthesia were 0.892,0.813,and 0.982,respectively.
Conclusions The emergency conversion to general anesthesia predictive scale constructed in this study has good predictive value for emergency conversion to general anesthesia during MT in patients with AIS.关键词
卒中/机械取栓/麻醉/紧急全身麻醉转换/预测Key words
Stroke/Mechanical thrombectomy/Anesthesia/Emergency conversion to general anesthesia/Prediction分类
医药卫生
