急性缺血性卒中机械取栓术中紧急全身麻醉转换的预测量表构建

doi:10.3969/j.issn.1673-5765.2025.03.009

摘要/Abstract

摘要： 目的构建急性缺血性卒中（acute ischemic stroke，AIS）患者机械取栓术中紧急全身麻醉转换的预测量表。
方法回顾性纳入2020年1月—2023年12月于南京医科大学第一附属医院接受机械取栓治疗的AIS患者。依据麻醉方式分为局部麻醉/监测麻醉管理组和紧急全身麻醉转换组。采用多因素logistic回归分析机械取栓术中紧急全身麻醉转换的危险因素，并基于多因素logistic回归分析结果对各危险因素进行赋分，建立预测量表。
结果共纳入接受机械取栓治疗的AIS患者864例，其中局部麻醉/监测麻醉管理组803例（92.9%），紧急全身麻醉转换组61例（7.1%）。多因素logistic回归分析显示NIHSS评分≥15分（OR 1.53，95%CI 1.27～1.78）、ASPECTS<6分（OR 1.40，95%CI 1.21～1.70）、失语（OR 1.62，95%CI 1.30～1.91）及椎基底动脉闭塞（OR 2.21，95%CI 1.82～2.96）与机械取栓术中紧急全身麻醉转换独立相关。基于上述4个独立危险因素构建紧急全身麻醉转换预测量表[NIHSS评分≥15分（1分）、ASPECTS<6分（1分）、失语（1分）和椎基底动脉闭塞（2分）]。该量表预测接受机械取栓治疗的AIS患者术中紧急全身麻醉转换的最佳截断值为3分。当量表评分≥3分时，AUC为0.853，预测紧急全身麻醉转换的敏感度为0.892，特异度为0.813，阴性预测值为0.982。
结论本研究所构建的紧急全身麻醉转换预测量表对AIS患者机械取栓术中紧急全身麻醉转换具有良好的预测价值。

文章导读： 本研究构建了基于NIHSS评分（1分）、ASPECTS（1分）、失语（1分）及椎基底动脉闭塞（2分）4个独立危险因素的急性缺血性卒中机械取栓术中紧急全身麻醉转换预测量表。量表评分≥3分时预测效能最佳（AUC=0.853）。该量表可优化术前麻醉决策，减少围手术期风险，提高临床管理精准度。

关键词: 卒中; 机械取栓; 麻醉; 紧急全身麻醉转换; 预测

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 (OR 1.53, 95%CI 1.27-1.78), ASPECTS<6 points (OR 1.40, 95%CI 1.21-1.70), aphasia (OR 1.62, 95%CI 1.30-1.91), and vertebrobasilar artery occlusion (OR 2.21, 95%CI 1.82-2.96) 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 cutoff value 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.

Key words: Stroke; Mechanical thrombectomy; Anesthesia; Emergency conversion to general anesthesia; Prediction

中图分类号:

李传游, 盛蕾, 郭雪艳, 刘元月. 急性缺血性卒中机械取栓术中紧急全身麻醉转换的预测量表构建[J]. 中国卒中杂志, 2025, 20(3): 320-327.

LI Chuanyou, SHENG Lei, GUO Xueyan, LIU Yuanyue. The Construction of a Predictive Scale for Emergency Conversion to General Anesthesia during Mechanical Thrombectomy for Acute Ischemic Stroke[J]. Chinese Journal of Stroke, 2025, 20(3): 320-327.

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