替罗非班在颅内动脉瘤支架辅助栓塞术中抗血小板聚集的临床研究  

Antiplatelet therapy study of tirofiban in stent-assisted embolization of intracranial aneurysms

作　　者：金二亮 祝源[1] 杨李[1] 陈刚 李欢欢[1] 赵曰圆[1] 盛柳青[1] 汤伟[1] 杨铭[1] 潘力[1] 李俊[1] Jin Erliang Zhu Yuan Yang Li Chen Gang Li Huanhuan Zhao Yueyuan Sheng Liuqing Tang Wei Yang Ming Pan Li Li Jun.(Department of Neurosurgery, Wuhan Clinical College of Southern Medical University, Wuhan General Hospital of People＇s Liberation Army of China, Wuhan 430070, Chin)

机构地区：[1]南方医科大学武汉临床医学院,中国人民解放军武汉总医院神经外科,武汉430070

出　　处：《中华神经外科杂志》2017年第4期349-353,共5页Chinese Journal of Neurosurgery

基　　金：湖北省卫生和计划生育委员会项目（WJ2017M157）

摘　　要：目的探讨颅内动脉瘤支架辅助栓塞术中应用盐酸替罗非班抗血小板聚集的有效性及安全性。方法回顾性分析2014年1月至2015年12月在中国人民解放军武汉总医院神经外科行支架辅助弹簧圈栓塞治疗的309例颅内动脉瘤患者的临床资料，其中颅内破裂动脉瘤213例，未破裂动脉瘤79例，动脉瘤复发9例，外伤性假性动脉瘤8例。成功置入支架后即可给予盐酸替罗非班[2～4μg／kg（2—4ml）]，术后继续持续泵人24h，次日过渡到口服抗血小板聚集药物。结果309例颅内动脉瘤中，应用盐酸替罗非班期间动脉瘤再出血6例（1．9％），支架内血栓形成2例（0．6％），气管隆突处渗血1例（0．3％）。其中298例术后12～24h成功过渡到口服抗血小板聚集药物。76例患者的血小板活化率（激活后CD62p）在术前、术后1d的平均值分别为（75．7±10．4）％和（71．9±15．9）％（t=2．147，P=0．035）；133例患者的血小板活化率（激活后CD62p）在术前、术后3d后的平均值分别为（73．2±13．2）％和（27．9±22．1）％（t=20．25，P〈0．001）。结论颅内动脉瘤支架辅助栓塞治疗中应用盐酸替罗非班抗血小板治疗安全有效，但有出血倾向的患者应用时需慎重。监测血小板活化状态能够客观反映血小板的抑制情况，对抗血小板聚集药物的临床应用具有指导意义。Objective To investigate the efficacy and safety of antiplatelet therapy with tirofiban in stent-assisted embolization of intracranial aneurysms. Methods The clinic data of 309 patients with intracranial aneurysms were retrospectively studied, who were admitted to Wuhan General Hospital of People＇s Liberation Army of China from January 2014 to December 2015 and treated with stent-assisted embolization. The cases included 213 ruptured aneurysms and 79 unruptured aneurysms. After successful stenting, tirofiban was administered with intravenous bolus injection [ 2 -4 μg/kg （about 2 -4 ml） ], continuously infused with pump for 24 hours and followed by gradual switch to oral administration of platelet aggregation inhibitors. Results In the 309 patients with intracranial aneurysms, complications that occurred during the application of tirofihan included rerupture of aneurysms in 6 cases （1.9%） , thrombosis in 2 cases （0.6%） and bleeding in trachea carina in 1 case （0. 3% ）. Among them, 298 cases had successfully transitioned from tirofiban to oral platelet aggregation inhibitors 12 -24 hours post surgery. For 76 patients, there was significant difference in the average rate of platelet activation between preoperative and 1-day postoperative （CD62p） levels 75.7 ± 10.4% vs. 71.9 ± 15.9%, respectively, P = 0.035 ）. For 133 patients, there was also significant difference in the average rate of platelet activation between preoperative and 3-day postoperative levels 73. 2 ± 13.2% vs. 27.9 ± 22.1%, respectively, P 〈 0.001 ）. Conclusions Antiplatelet threapy with tirofiban for patients with stent-assisted embolization of intracranial aneurysms is relatively safe and effective, but cautions need to be taken in cases with hemorrhagic tendency. The platelet activation test could objectively reveal the inhibition of platelets and help guide the clinical administration of platelet aggregation inhibitors.

关 键 词：颅内动脉瘤 支架 栓塞 治疗性 血小板聚集抑制剂 替罗非班 

分 类 号：R743[医药卫生—神经病学与精神病学]