血栓弹力图对支架辅助颅内栓塞动脉瘤不同剂量抗血小板聚集药物疗效的初步评价  

Thromboelastographic evaluation of the different dosage anti-platelet aggregation drugs on stentassisted embolization of intracranial aneurysms

作　　者：张翔圣[1] 张鑫[1] 张庆荣[1] 吴琪[1] 陈姝娟[1] 

机构地区：[1]南京军区南京总医院神经外科,210002

出　　处：《中国脑血管病杂志》2015年第3期130-133,159,共5页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的采用血栓弹力图检查(TEG)评估支架辅助栓塞动脉瘤患者术前不同剂量阿司匹林及氯吡格雷联合治疗方案对血小板抑制率的影响。方法回顾性连续纳入南京军区南京总医院接受支架辅助栓塞动脉瘤的57例未破裂动脉瘤患者,并按阿司匹林口服剂量的不同分为低剂量组(阿司匹林100 mg+氯吡格雷75 mg)26例和高剂量组(阿司匹林300 mg+氯吡格雷75 mg)31例。两组患者均于术前开始服用阿司匹林及氯吡格雷,于服药第3天,采用TEG检测患者花生四烯酸(AA)途径血小板抑制率和二磷酸腺苷(ADP)途径血小板抑制率。比较两组患者血小板抑制情况以及药物抵抗的发生情况。结果 (1)服药3 d血小板抑制率:低剂量组AA抑制率及ADP抑制率分别为(76±21)%、(72±26)%;高剂量组AA抑制率及ADP抑制率分别为(80±21)%、(73±29)%,两组抑制率差异均无统计学意义(均P>0.05)。(2)药物抵抗:低剂量组发生阿司匹林抵抗2例(7.7%),氯吡格雷抵抗1例(3.8%);高剂量组中发生阿司匹林抵抗3例(9.7%),氯吡格雷抵抗4例(12.9%);两组患者阿司匹林抵抗及氯吡格雷抵抗的发生率差异均无统计学意义(均P>0.05)。(3)围手术期缺血并发症:低剂量组中1例(3.8%)发生围手术期缺血事件,高剂量组中2例(6.5%)发生围手术期缺血事件,两组围手术期缺血并发症发生率差异无统计学意义(P>0.05)。结论对支架辅助栓塞动脉瘤患者,TEG评价的低剂量与高剂量抗血小板聚集治疗对血小板抑制效果无明显差异。Objective To evaluate the effects of different dosage of aspirin and clopidogrel on the platelet inhibition rate by thromboelastography（ TEG） before stent-assisted embolization of aneurysms.Methods The clinical data of 57 patients with unruptured aneurysms treated by stent-assisted coil embolization in General Hospital of Nanjing Military Command were analyzed retrospectively. The patients were divided into a low dose group（ aspirin 100 mg ＋ clopidogrel 75 mg,26 cases） and a high dose group（ aspirin 300 mg ＋clopidogrel 75 mg,31 cases）. All the patients were treated with aspirin and clopidogrel before surgery. The blood samples were collected on day 3 after oral administration with anti-platelet aggregation drugs. TEG was used to detect the arachidonic acid（ AA）-induced inhibition rate of platelet aggregation and adenosine diphosphate（ ADP）-induced inhibition rate of platelet aggregation. The platelet inhibition and drug resistance,as well as ischemic complications in the perioperative period between the two groups were compared. Results（ 1） The platelet inhibition rates： there was no significant difference in the inhibition rates of platelet aggregation of AA and ADP between low dose group and high dose group at day 3 after oral antiplatelet drugs [AA inhibition rate：（ 76 ± 21） % vs.（ 80 ± 21） %; ADP inhibition rate：（ 72 ± 26） % vs.（ 73 ± 29） %; all P 0. 05 ].（ 2） Drug resistance： in the low dose group,the patients of aspirin and clopidogrel resistant were 2 cases（ 7. 7%） and 1 case（ 3. 8%）,and the patients in high dose group were 3 cases（ 9. 7%） and 4 cases（ 12. 9%）. No statistical significant difference in the aspirin and clopidogrel resistant was detected in the two groups（ all P〉0. 05）.（ 3） The ischemic complications in the perioperative period：there was 1 case（ 3. 8%） with ischemic complications in the low dose group,and 2 cases（ 6. 5%） in the high dose group. There was no significance difference in the incidence

关 键 词：支架 栓塞 治疗性 颅内动脉瘤 阿司匹林 氯吡格雷 血栓弹力图 

分 类 号：R743[医药卫生—神经病学与精神病学]