血小板活化功能监测指导抗血小板凝集措施在颅内动脉瘤栓塞治疗术后的应用研究  

Application of platelet activation monitoring to guide anti-platelet coagulation measures in the treatment of intracranial aneurysms after embolization

作　　者：张建宇 徐静娜 徐永康 沈益金 ZHANG Jianyu;XU Jingna;XU Yongkang(Yinzhou People's Hospital of Ningbo,Zhejiang 315100,China.)

机构地区：[1]浙江省宁波市鄞州人民医院,宁波315100

出　　处：《浙江创伤外科》2020年第2期211-214,共4页Zhejiang Journal of Traumatic Surgery

摘　　要：目的 研究血小板活化功能监测指导抗血小板凝集措施在颅内动脉瘤栓塞治疗术后的应用效果.方法 选择2017年7月至2019年7月在本院进行支架辅助弹簧圈栓塞的44例颅内动脉瘤患者作为本次的研究对象进行研究.于释放支架后在术中选择替罗非班进行静脉注射,剂量为2.5~3.0μg/kg,之后以2.5~3.0mg·kg-1·h-1作为注射速度进行静脉输注,24小时后停止替罗非班的使用,次日通过口服或胃管给予氯吡格雷75mg/d+阿司匹林100mg/d进行双抗治疗.术后以患者的病情以及血小板被抑制状态对用药的剂量进行调整.结果 术中在给予盐酸替罗非班之前有1例(2.27%)患者再次出现颅内动脉瘤,使用替罗非班期间有1例(2.27%)患者出现动脉瘤再破裂出血的情况,经过处理后患者情况均得到恢复.44例患者的激活后CD62p即血小板活化率在盐酸替罗非班的使用期间期间术前、术后1天的平均值分别为(75.6± 10.5)%和(71.9±16.1)%,数据比较差异有统计学意义(t=2.1468,P=0.0349).44例患者术前与手术后第1天的血小板计数平均值分别为(206.25± 55.61)×109/L和(188.13±54.5)×109/L,数据比较差异有统计学意义(t=4.7663,P=0.0002).4例患者的部分活化凝血酶时间(APT)在术前、与手术后1 天的平均值为(32.08±3.87)秒和(32.23±3.89)秒,数据比较差异无统计学意义(t=-0.1798,P=0.8587).术后在进行双抗治疗的阶段,有1 例(2.27%)患者出现动脉瘤再次破裂的情况,术后1天有1例(2.27%)患者出现皮下瘀斑,血小板活化率激活后CD62p=13.5%,结果显示患者出现较强的血小板聚集抑制,通过调整方案对氯吡格雷剂量减半情况得到有效改善.结论 血小板活化功能监测血小板的活化状态对颅内动脉瘤栓塞治疗术后选择抗血小板凝集措施有临床应用指导意义.Objective To study the effect of platelet activation monitoring and anti-platelet coagulation measures in the treatment of intracranial aneurysms after embolization.Methods 44 patients with intracranial aneurysms who underwent stent-assisted coil embolization in our hospital from July 2017 to July 2019 were selected as the subjects of this study.Tirofiban were injected intravenously at a dose of 2.5~3.0μg/kg after stent release,and then intravenously at a rate of 2.5~3.0mg·kg-1·h-1.Tirofiban were discontinued 24 hours later,and clopidogrel 75 mg/d+aspirin 100 mg/d was given orally or through gastric tube the next day.After operation,the dosage of the drug were adjusted according to the patients condition and platelet inhibition.Results Intracranial aneurysms recurred in 1 patient(2.27%)before the administration of tirofiban hydrochloride,and aneurysm rupture and bleeding occurred in 1 patient(2.27%)during the use of tirofiban,after treatment the patients recovered.The mean platelet activation rates of CD62p after activation in 44 patients before and after tirofiban hydrochloride treatment were(75.6+10.5)%and(71.9+16.1)%,there were a significant difference(t=2.1468,P=0.0349).The mean platelet counts of 44 patients before and on the first day after operation were(206.25+55.61)×109/L and(188.13+54.5)×109/L,there were significant difference(t=4.7663,P=0.0002).The mean values of partial activated thrombin time(APT)of 4 patients before operation and 1 day after operation were(32.08+3.87)s and(32.23+3.89)s,there were no significant difference(t=-0.1798,P=0.8587).At the stage of antiplatelet therapy,1 patient(2.27%)had aneurysm rupture again,1 patient(2.27%)had subcutaneous ecchymosis one day after operation,CD62p=13.5%after platelet activation rate activation.The results showed that patients had strong platelet aggregation inhibition,and the dosage halving of clopidogrel were effectively improved by adjusting the scheme.Conclusion The monitoring of platelet activation by platelet activation function is of clinical

关 键 词：血小板聚集抑制剂 颅内动脉瘤 栓塞 支架 替罗非班 应用效果 

分 类 号：R743.3[医药卫生—神经病学与精神病学]