替罗非班对颅内未破裂动脉瘤支架辅助弹簧圈栓塞围手术期血栓事件发生的影响研究  

Effect of tirofiban on perioperative thrombotic events in patients with unruptured intracranial aneurysms accepted stent-assisted coil embolization

作　　者：刘华坤[1] 王鹏[1] 张磊[1] 刘朝来[1] 周亚飞[1] 卢哲 李晖[1] 闫中瑞[1] 初建峰[1] Liu Huakun;Wang Peng;Zhang Lei;Liu Chaolai;Zhou Yafei;Lu Zhe;Li Hui;Yan Zhongrui;Chu Jianfeng(Department of Neurology,Jining Firs People's Hospital,Jining 272111,China)

机构地区：[1]济宁市第一人民医院神经内科,272111

出　　处：《中华神经医学杂志》2020年第8期794-798,共5页Chinese Journal of Neuromedicine

摘　　要：目的探讨术前口服阿司匹林及氯吡格雷基础上术中预防性加用替罗非班在颅内未破裂动脉瘤支架辅助弹簧圈栓塞围手术期的安全性及其对血栓事件发生的影响。方法回顾性收集济宁市第一人民医院神经内科自2016年1月至2019年12月行支架辅助弹簧圈栓塞治疗的275例颅内未破裂动脉瘤患者的临床资料,其中自2016年1月至2017年12月收治的110例患者在术前仅接受传统的口服阿司匹林及氯吡格雷联合抗血小板处理(经典组).自2018年I月至2019年12月收治的165例患者在术前口服阿司匹林及氯吡格雷基础上术中预防性加用替罗非班(改良组),对比分析2组患者围手术期的安全性及血栓事件发生的差异。结果经典组与改良组术中可视血栓事件发生率分别为6.4%(7/110)和1.2%(2/165).差异有统计学意义(P<0.05);术后血栓事件发生率分别为4.5%(5/110)和2.4%(4/165).差异无统计学意义(P>0.05);尿道黏膜出血发生率分别为9.1%(10/110)和21.2%(35/165),差异有统计学意义(P<0.05);牙龈出血发生率分别为13.6%(15/110)和19.4%(32/165),差异无统计学意义(P>0.05)。2组患者均未有急性消化道出血及脑出血发生,尿道黏膜出血及牙龈出血均为一过性,均自行缓解。结论支架辅助弹簧圈栓塞治疗颅内未破裂动脉瘤时,在术前口服阿司匹林及氯吡格雷基础上,术中预防性加用替罗非班可以减少术中可视血栓事件的发生,且不明显增加出血风险。Objeetive To investigate the safety of intraoperative prophylactic addition of tirofiban on the basis of preoperative oral administration of aspirin and clopidogrel in patients with unruptured intracranial aneurysms accepted stent-assisted coil embolization,and explore the effect of tirofiban on perioperative thrombotic events.Methods The clinical data of 275 patients with unruptured intracranial aneurysms who underwent stent assisted coil embolization in our hospital from January 2016 to December 2019 were retrospectively collected.Among them,110 patients admitted to our hospital from January 2016 to December 2017 only received preoperative oral administration of aspirin and clopidogrel combined with antiplatelet treatment(classic group),and 165 patients admited to out hospital from January 2018 to December 2019 received intraoperative prophylactic addition of tirofiban on the basis of preoperative oral administration of aspirin and clopidogrel(improved group).The differences of perioperative safety and thrombotic events between the two groups were compared and analyzed.Results The incidence of intraoperative visual thrombotic events in the classic group and the improved group were 6.4%(7/110)and 1.2%(2/165),respectively,with significant difference(P<0.05);the incidence of postoperative thrombotic events was 4.5%(5/110)and 2.4%(4/165),respectively,without significant difference(P>0.05);the incidence of urethrorrhagia was 9.1%(10/110)and 21.2%(35/165).respectively,with significant difference(P<0.05);and the incidence of gingival hemorrhage was 13.6%(15/110)and 19.4%(32/165),respectively,without significant difference(P>0.05).No acute gastrointestinal hemorrhage or cerebral hemorrhage occurred in both groups;urethrorrhagia and gingival hemorthage were transient and relieved spontaneously.Conclusion Intraoperative prophylactic addition of tirofiban on the basis of preoperative oral administration of aspirin and clopidogrel can reduce the incidence of intraoperative visual thrombotic events without increasing the ri

关 键 词：替罗非班 安全性 血栓事件 支架辅助 弹簧圈 颅内未破裂动脉瘤 

分 类 号：R651.1[医药卫生—外科学]