Oxygen Saturation and Postoperative Mortality in Patients With Acute Ischemic Stroke Treated by Endovascular Thrombectomy
急性缺血性脑卒中患者行血管内血栓移除术治疗的氧饱和度及术后死亡率
Abstract
BACKGROUND: Monitored anesthesia care (MAC) and general anesthesia (GA) with endotracheal intubation are the 2 most used techniques for patients with acute ischemic stroke (AIS) undergoing endovascular thrombectomy. We aimed to test the hypothesis that increased arterial oxygen concentration during reperfusion period is a mechanism underlying the association
between use of GA (versus MAC) and increased risk of in-hospital mortality.
背景：气管插管监测麻醉护理(MAC)和全麻(GA)是急性缺血性脑卒中(AIS)患者最常用的两种技术。我们的目的是检验再灌注期间动脉氧浓度的增加是使用GA(相对于MAC)和住院死亡风险增加之间关联的机制
METHODS: In this retrospective cohort study, data were collected at the Cleveland Clinic between 2013 and 2018. To assess the potential mediation effect of time-weighted average oxygen saturation (Spo2) in first postoperative 48 hours between the association between GA versus MAC and in-hospital mortality, we assessed the association between anesthesia type and post-operative Spo2 tertiles (exposure–mediator relationship) through a cumulative logistic regression model and assessed the association between Spo2 and in-hospital mortality (mediator–outcome relationship) using logistic regression models. Confounding factors were adjusted for using propensity score methods. Both significant exposure–mediator and significant media
tor–outcome relationships are needed to suggest potential mediation effect.
方法：在本回顾性队列研究中，数据收集于2013年至2018年在Cleveland诊所进行的。为了评估时间加权平均氧饱和度(Spo2)在术后第一次48小时内GA与MAC和住院死亡率之间的潜在中介效应，我们通过累积逻辑回归模型评估麻醉类型和术后Spo2三分位数（暴露-中介关系）之间的关系，并使用逻辑回归模型评估Spo2和住院死亡率（中介-结果关系）之间的关系。使用倾向评分方法调整了混杂因素。我们需要显著的暴露-中介关系和显著的中介-结果关系来提示潜在的中介效应。
RESULTS: Among 358 patients included in the study, 104 (29%) patients received GA and 254 (71%) received MAC, with respective hospital mortality rate of 19% and 5% (unadjusted P value
<.001). GA patients were 1.6 (1.2, 2.1) (P < .001) times more likely to have a higher Spo2 tertile as compared to MAC patients. Patients with higher Spo2 tertile had 3.8 (2.1, 6.9) times higher odds of mortality than patients with middle Spo2 tertile, while patients in the lower Spo2 tertile did not have significant higher odds compared to the middle tertile odds ratio (OR) (1.8 [0.9,
3.4]; overall P < .001). The significant exposure–mediator and mediator–outcome relationships suggest that Spo2 may be a mediator of the relationship between anesthetic method and mortality. However, the estimated direct effect of GA versus MAC on mortality (ie, after adjusting for Spo2; OR [95% confidence interval {CI}] of 2.1 [0.9–4.9]) was close to the estimated association ignoring Spo2 (OR [95% CI] of 2.2 [1.0–5.1]), neither statistically significant, suggesting that Spo2 had at most a modest mediator role.
结果：这项研究共纳入358名患者。104名患者（29%）接受GA，254名（71%）患者接受MAC，住院死亡率分别是19%和5%。(P＜0.01）。与MAC患者相比，GA患者Spo2三分位数高1.6倍(P < .001)。高Spo2三分位数组死亡率是中Spo2三分位数组的3.8倍。但低三分位数组与中三分位数组SPO2死亡率之间并无差异(OR) (1.8 [0.9, 3.4]; P < .001)。暴露-中介和中介-结果关系分析显示，Spo2或许是麻醉方法与死亡率关系之间的中介因素。然而，两种方法对死亡率的直接效应与忽略Spo2时接近，也无显著的统计学效应。OR [95% [CI]:2.1 [0.9–4.9])(OR [95% CI] 2.2 [1.0–5.1]),这表明Spo2的确起到了一定的中介作用。
CONCLUSIONS: GA was associated with a higher Spo2 compared to MAC among those treated by endovascular thrombectomy for AIS. Spo2 values that were higher than the middle tertile were associated with higher odds of mortality. However, GA was not significantly associated with higher odds of death. Spo2 at most constituted a modest mediator role in explaining the
relationship between GA versus MAC and mortality.
结论：急性卒中患者血管内血栓切除术中，GA有着更高的Spo2 若Spo2高于三分位数，有着更高的死亡率。然而，GA与死亡率无明显关系。但Spo2数值仍在两种麻醉方式与死亡率之间起着一定的中介作用。
笔记/Danny