比较全静脉麻醉与吸入麻醉在急性缺血性卒中血管内治疗中的效果：系统综述与网状Meta分析
贵州医科大学 麻醉与心脏电生理课题组
翻译：周倩 编辑：周倩 审校：曹莹
本研究旨在比较全静脉麻醉（TIVA）与吸入麻醉在急性缺血性卒中患者血管内治疗中的效果差异。尽管两种麻醉方式对脑血流动力学的影响不同，但现有证据对最佳麻醉方案的选择仍存在争议。
方法
通过系统检索Medline、Embase、Cochrane、CINAHL、Web of Science和Scopus等数据库。筛选出采用全身麻醉下血管内治疗的英文研究，这些研究对象为接受TIVA或吸入麻醉的成年急性缺血性卒中患者，并收集了血管内治疗后90天内使用改良Rankin量表（mRS≤2）评估的有利功能结局分类数据。通过计算比值比（OR）和标准化均值差，构建了网络荟萃分析模型，该模型允许将全身麻醉与清醒镇静两种方式的对比研究纳入分析。
结果
本次检索共获得6235篇文献，其中符合纳入标准的有15篇。研究类型包括：3项直接对比TIVA与吸入麻醉的研究，12项比较全身麻醉与清醒镇静的研究。研究对象总数达3015人（清醒镇静组：n=1067；全身麻醉组：n=1948，其中TIVA组：n=1212，吸入麻醉组：n=736）。结果显示：在90天神经功能恢复（OR=1.25，95% CI 0.81–1.91；p=0.31）、90天死亡率（OR=0.72，95% CI 0.42–1.24；p=0.24）、成功再通率（OR=1.33，95% CI 0.70–2.52；p=0.39）及再通时间（标准化均值差=0.03，95% CI -0.35–0.41；p=0.88）方面，TIVA组与吸入麻醉组无显著差异。此外，清醒镇静组与TIVA组在90天神经功能恢复（OR=1.14,95%CI：0.84–1.53；p=0.40）、90天死亡率（OR=0.87,95%CI：0.62–1.23；p=0.43）、成功再通率（OR=0.76,95%CI：0.52–1.10；p=0.15）及再通时间（标准化均值差=–0.18,95%CI：–0.47–0.11；p=0.23）方面均无显著差异；清醒镇静组与吸入麻醉组在90天神经功能恢复（OR=1.42,95%CI：0.92–2.17；p=0.11）、90天死亡率（OR=0.63,95%CI：0.36–1.12；p=0.11）、成功再通率（OR=1.01,95%CI：0.52–1.94；p=0.98）及再通时间（标准化均值差=–0.15,95%CI：–0.52–0.23；p=0.44）方面也无显著差异。
本网络荟萃分析表明，TIVA与吸入麻醉在急性缺血性卒中血管内治疗中的效果无显著差异。但研究存在异质性，且样本量不足以分析麻醉药物、临床特征或手术因素的潜在影响。未来需进一步开展高质量随机对照试验验证结果。
原始文献：Plitman E, Mohammed A, Rajaleelan W, et al Comparing General Anesthesia-Based Regimens for Endovascular Treatment of Acute Ischemic Stroke: A Systematic Review and Network Meta-Analysis. Anesth Analg. 2025 Nov 1;141(5):1052-1066. doi: 10.1213/ANE.0000000000007357. Epub 2025 Oct 20. PMID: 39832221.
Comparing General Anesthesia-Based Regimens for Endovascular Treatment of Acute Ischemic Stroke: A Systematic Review and Network Meta-Analysis
ABSTRACT
Background: Total intravenous anesthesia (TIVA)-based and volatile-based general anesthesia have different effects on cerebral hemodynamics. The current work compares these 2 regimens in acute ischemic stroke patients undergoing endovascular therapy.
Methods: We conducted a systematic literature search across MEDLINE, Embase, Cochrane, CINAHL, Web of Science, and Scopus. We identified English language studies including adult acute ischemic stroke patients managed with endovascular therapy under general anesthesia delineable into TIVA only and/or volatile only, and obtained categorical data for favorable functional outcomes using the modified Rankin scale (mRS ≤2), at 90 days after endovascular therapy. Odds ratios (OR) and standardized mean differences were calculated to inform a network meta-analysis approach, which permitted the inclusion of studies comparing a form of general anesthesia (ie, TIVA only or volatile only) to conscious sedation.
Results: The search rendered 6235 articles, of which 15 met inclusion criteria. Three studies directly investigated TIVA versus volatile, whereas 12 studies compared general anesthesia to conscious sedation. The total number of subjects was 3015 (conscious sedation: n = 1067; general anesthesia: n = 1948 [TIVA: n = 1212, volatile: n = 736]). No significant differences were identified between TIVA and volatile groups in 90-day neurological outcome (OR = 1.25, 95% confidence interval [CI], 0.81-1.91; P = .31), 90-day mortality (OR = 0.72, 95% CI, 0.42-1.24; P = .24), successful recanalization (OR = 1.33, 95% CI, 0.70-2.52; P = .39), or recanalization time (standardized mean difference = 0.03, 95% CI, -0.35 to 0.41; P = .88). Additionally, no significant differences were identified between the conscious sedation group and the TIVA group in 90-day neurological outcome (OR = 1.14, 95% CI, 0.84-1.53; P = .40), 90-day mortality (OR = 0.87, 95% CI, 0.62-1.23; P = .43), successful recanalization (OR = 0.76, 95% CI, 0.52-1.10; P = .15), or recanalization time (standardized mean difference = -0.18, 95% CI, -0.47 to 0.11; P = .23), and between the conscious sedation group and the volatile group in 90-day neurological outcome (OR = 1.42, 95% CI, 0.92-2.17; P = .11), 90-day mortality (OR = 0.63, 95% CI, 0.36-1.12; P = .11), successful recanalization (OR = 1.01, 95% CI, 0.52-1.94; P = .98), or recanalization time (standardized mean difference = -0.15, 95% CI, -0.52 to 0.23; P = .44).
Conclusions: This network meta-analysis showed that the perioperative use of either general anesthesia-based regimen, or sedation, did not significantly impact various endovascular therapy-related outcomes. However, the current work was underpowered to detect differences in anesthetic agents, clinico-demographic characteristics, or procedural factors.