脑室外引流后早期血管内治疗破裂脑动脉瘤使用双联抗血小板和肝素的安全性研究  

Study on safety of dual antiplatelet and heparin in early endovascular treatment for ruptured cerebral aneurysms after external ventricular drainage

作　　者：康俊龙[1] 陈锷[1] 丰伟[1] 田新华[1] 黄延林[1] 张俊卿[1] 刘忠 KANG Jun-long;CHEN E;FENG Wei(Department of Neurosurgery,Zhongshan Hospital,Xiamen University,Xiamen 361000,China)

机构地区：[1]厦门大学附属中山医院神经外科

出　　处：《临床神经外科杂志》2020年第1期77-81,共5页Journal of Clinical Neurosurgery

基　　金：厦门市重要重大疾病联合攻关项目(3502Z20179046);国家重点研发计划重大慢性非传染性疾病防控研究重点专项(2016YFC1300800)

摘　　要：目的研究动脉瘤性蛛网膜下腔出血(aSAH)合并急性脑积水行脑室外引流术后6 h内及24 h内行血管内治疗使用双联抗血小板药物及肝素的安全性。方法回顾性分析19例动脉瘤性蛛网膜下腔出血患者的临床资料。患者均合并急性脑积水,均先行脑室外引流术,均在术后24 h内行血管内治疗,治疗前鼻饲氯吡格雷300 mg和阿司匹林300 mg,治疗中使用肝素。记录脑室外引流术和使用肝素之间的时间间隔,分析不同间隔时间肝素使用的相关出血风险的差别。结果19例患者中,有13例患者采用支架辅助弹簧圈栓塞,2例患者采用球囊辅助弹簧圈栓塞,1例患者采用双微导管弹簧圈栓塞,3例患者采用单微导管弹簧圈栓塞;12例患者在脑室外引流术后6 h内行血管内治疗,7例患者在脑室外引流术后6~24 h之间进行治疗。2例(16.67%)脑室外引流术后6 h内行血管内治疗的患者出现少量的穿刺道出血,其余17例患者未出现脑室外引流术相关的出血。术中1例患者出现中央沟动脉血栓形成,使用替罗非班溶栓治疗后血管再通。结论对于动脉瘤性蛛网膜下腔出血并发急性脑积水的患者,在脑室外引流后6 h内和24 h内行血管内治疗动脉瘤使用双联抗血小板药物和肝素是安全的。脑室外引流术后早期血管内治疗颅内破裂动脉瘤是安全、可行的。Objective To analyze the safety of endovascular treatment with dual antiplatelet and heparin within 6 h and 24 h after external ventricular drainage(EVD)for aneurysmal subarachnoid hemorrhage(aSAH)combined with acute hydrocephalus.Methods The clinical data of 19 consecutive cases of(aSAH)were analyzed retrospectively.All patients were combined with acute hydrocephalus who underwent EVD first,endovascular treatment was performed within 24 hours after surgery,300 mg clopidogrel and 300 mg aspirin were given by nasal feeding before anesthesia,and heparin was used intraoperatively.The time interval between EVD and the use of heparin was recorded and the risk of hemorrhage associated with EVD at different time intervals was analyzed.Results Of 19 patients,13 were stent-assisted coiling,2 were balloon assisted coil,1 was double micro-catheter coiling and 3 were single micro-catheter coiling.Of 19 patients,12 received endovascular treatment within 6 hours after EVD,and 7 received endovascular treatment within 6-24 hours after EVD.A small amount of puncture channel bleeding occurred in 2 cases underwent endovascular treatment within 6 hours after EVD,while no external ventricular drainage related bleeding occurred in the remaining 17 cases.During the operation,thrombosis of the central sulcus artery occurred in 1 patient,and tirofiban was used to make recanalization.Conclusions For patients with aSAH complicated with acute hydrocephalus,it is safe to apply dual antiplatelet and heparin in endovascular treatment of aneurysms within 24 hours after EVD.Endovascular treatment within 6 hours after EVD using dual antiplatelet and heparin is safe.It is safe and feasible to treat ruptured aneurysms in early stage after EVD.

关 键 词：脑室外引流 抗血小板药物 肝素 脑动脉瘤 血管内治疗 脑出血 

分 类 号：R651.12[医药卫生—外科学]