经颈静脉门体分流术后预防支架内血栓形成及消化道出血临床研究  

Effect of different administration regimens of antiplatelet treatment on stent thrombosis and gastrointestinal bleeding events after transjugular intrahepatic portosystemic shunt procedure

作　　者：陈蒙君 吴建胜[1] 董乐妹[1] 金尹[1] 黄智铭[1] 吴伟[1] 

机构地区：[1]温州医科大学附属第一医院消化内科,浙江温州325000

出　　处：《中国实用内科杂志》2017年第9期826-829,共4页Chinese Journal of Practical Internal Medicine

基　　金：浙江省自然科学基金项目(LY15H030017)

摘　　要：目的观察经颈静脉门体分流(TIPS)术后不同抗血小板治疗方案对支架内血栓形成以及消化道出血事件的影响。方法选取2013年6月至2014年6月于温州医科大学附属第一医院行TIPS术的乙型肝炎后肝硬化失代偿期患者共计60例,将其随机分为两组,每组30例。试验组行TIPS术后予长期服用阿司匹林及氯吡格雷1年,对照组行TIPS术后予氯吡格雷1年,术后长期随访,定期B超复查门静脉支架血流通畅情况。结果 (1)随访期内试验组发生1例支架堵塞,对照组发生2例支架堵塞;(2)试验组有9例出现术后消化道出血事件,对照组有2例出现消化道出血事件。结论 TIPS术后联合用阿司匹林和氯吡格雷不能降低支架阻塞事件的发生,且具有较高的消化道出血风险。建议TIPS术后单用氯吡格雷抗血小板治疗。Objective To study the effect of different administration regimens of antiplatelet treatment on stent thrombosis and gastrointestinal bleeding events after transjugular intrahepatic portosystemic shunt procedure. Methods We measured thrombin generation by ultrasonography and liver function in the experimental group （n=30） using aspirin and clopidogrel within 1 year after TIPS procedure and compared the results with control group （n=30） using dopidogrel. Meantime, all gastrointestinal bleeding events were recorded. Results （1） At the end of the followed-up period, 1 patient developed portal vein stents thrombosis （PVST） in the dopidogrel group, compared with 2 in the control group （P〉0.05）; （2）Gastrointestinal bleeding events occnred in 9 patients in the experimental group, compared with 2 in the control group procedure. Conclusion The use of aspirin and dopidogrel therapy can＇t reduce the presence of stentts thrombotic events but has more gastrointestinal bleeding events. It＇s recommended that, clopidogrel be safely administered to cirrhotic patients after TIPS.

关 键 词：食管和胃静脉曲张 血小板聚集抑制剂 经颈静脉门体分流术 肝硬化 消化道出血 

分 类 号：R575.21[医药卫生—消化系统]