急性缺血性脑卒中患者的麻醉管理  

Anesthetic management for the acute ischemic stroke patients

作　　者：孙剑[1] 韩如泉[2] Sun Jion;Han Ruquan(Department of Anesthesiology, Beijing Fuxing Hospital, Affiliated to Capital Medical University, Bering 100038, China;Department of A nesthesiology, Beijing Tiantan Hospital, Affiliated to Capital Medical University, Beo＇ing 100050, China)

机构地区：[1]首都医科大学附属复兴医院麻醉科,北京100038 [2]首都医科大学附属北京天坛医院麻醉科,100050

出　　处：《国际麻醉学与复苏杂志》2018年第5期473-478,共6页International Journal of Anesthesiology and Resuscitation

基　　金：北京市医院管理局青苗基金（QML20150508）

摘　　要：背景 急性缺血性脑卒中（acute ischemic stroke, AIS）已成为我国国民的第一死因。随着介入材料和技术的发展，血管内治疗（endovascular treatment， EVT）显著提高了闭塞血管再通率，延长了治疗时间窗，显示了良好的应用前景。而在治疗过程中，选择全身麻醉还是局部麻醉或清醒镇静，一直饱受争议。 目的 了解目前关于AIS血管内介入治疗麻醉管理的现状。 内容 回顾AIS治疗的历程，归纳和总结近年来关于AIS血管内治疗中麻醉管理的研究，并对正在进行的前瞻性临床研究进行展望。 趋向 目前关于麻醉方式对于患者预后影响的前瞻性随机对照研究正在进行中。Background Acute ischemic stroke （AIS） is the leading cause of mortality in our country. With the development of intervention devices and technology, endovascular treatment （EVT） significantly increases the rate of recanalization of occluded blood vessels, prolongs the critical time window for treatment, and shows a good application prospect. But it is always arguable about the best anesthesia strategy to perform EVT. Objective To review the current strategiesi for anesthesia management in the AIS patients undergoing EVT. Content The apparent benefits of EVT to AIS, depend on the advances in the techniques and devices for this treatment. Additionally, anesthetic management is also a major factor to determine the efficacy of EVT in AIS treatment. General anesthesia can immobilize patients, confer excellent analgesia, and provide optimal ventilation. But, it may perturb the stability of hemodynamics, delay recanalization of occluded blood vessels, and promote the risk of inhalation of secretion and pulmonary infection. Local anesthesia can fulfill satisfying analgesic effects while retains wakefulness and stable hemodynamics, thus facilitates real-time functional monitoring of the nervous system. However, the body movement and agitation following inadequate analgesia sometimes perturb ventilation through the airway and compromise the therapeutic benefits of EVT. This article reviews efforts that have been made to improve the efficacy of EVT in AIS treatment under either general or local anesthesia. Trend Protection of brain ischemic penumbra is a major strategy for AIS treatment. The choice of general or local anesthesia should be personalized to take patients risks and requirements into consideration. Further prospective randomized controlled studies are demanded to evaluate the influence of general and local anesthesia on the function of the nervous system in AIS patients undergoing EVT.

关 键 词：急性缺血性脑卒中 血管内治疗 麻醉管理 

分 类 号：R614[医药卫生—麻醉学]