急诊支架辅助脑动脉瘤栓塞术抗血小板药物应用的对比研究  

The comparative study of different antiplatelet drugsforpatients underwent stent-assist intracranial aneurysm embolism surgery in emergency

作　　者：刘君鹏[1] 程琼[1] 李云飞[1] 李永坤[1] 汪银洲[1] LIU Junpeng;CHENG Qiong;LI Yunfei;LI Yongkun;WANG Yinzhou(Department of Neurology,Fujian Provincial Hospital,Provincial Clinical Medical College of Fujian Medical University,Fuzhou,Fujian,350001,China)

机构地区：[1]福建医科大学省立临床医学院,福建省立医院神经内科,福建福州350001

出　　处：《当代医学》2021年第2期8-11,共4页Contemporary Medicine

基　　金：福建省科技厅社发处的引导性项目(2017Y0019)。

摘　　要：目的比较研究替罗非班和阿司匹林联合氯吡格雷两种不同紧急抗血小板药物应用的有效性、安全性。方法回顾性分析本院2014年1月至2019年12月收治的265例蛛网膜下腔出血急诊行支架辅助脑动脉瘤弹簧圈栓塞术患者,按紧急抗血小板药物分为两组,A组为术前紧急予负荷剂量替罗非班静推,维持剂量泵入24 h后,改予阿司匹林100 mg+氯吡格雷75 mg,口服3个月;B组为术前紧急予阿司匹林300 mg+氯吡格雷300 mg,口服或鼻饲,术后24 h续予阿司匹林100 mg+氯吡格雷75 mg,口服3个月。对比两组术后支架内血栓形成率、出血率、梗死率、死亡率及NIHSS评分差异。结果与B组比较,A组术后胃肠道出血率和NIHSS评分均较低,差异具有统计学意义(P<0.05)。两组术后支架内血栓形成率、梗死率和死亡率比较差异无统计学意义。结论对蛛网膜下腔出血急诊行支架辅助脑动脉瘤弹簧圈栓塞术患者,术前负荷剂量及术后24 h维持剂量替罗非班与负荷剂量阿司匹林联合氯吡格雷顿服相比,安全性更高,患者术后神经功能恢复好。Objective To study the efficacy and safety of load dosage of tirofiban and aspirin combined with clopidogrelwere comparatively.Methods 265 subarachnoid hemorrhage patients underwent stent-assist aneurysm embolism surgery in our hospital from January 2014 to December 2019 were retrospectively analysed anddivide into two groups.Group A was treated with load dosage tirofiban just before stenting,followed with maintenance dosage tirofiban for 24 hours,then 100 mg aspirin and 75 mg clopidogrel were given for 3 months.Group B was treated with 300 mg aspirin and 300 mg clopidogrel orally or by nasal feeding at least 30 minutes before stenting,then 100 mg aspirin and 75 mg clopidogrel were also given for 3 months.Compare the difference of in-stent thrombosis,hemorrhage rate,infarction rate,mortality and NIHSS scores between two groups.Results Compared with group B,the post-operation gastrointestinal hemorrhage rate and NIHSS scores of group A were lower,the differences were statistically significant(P<0.05).There were no significant differences in the in-stent thrombosis rate,infarction rate and mortality.Conclusion For the subarachnoid hemorrhage patients underwent urgent stent-assist aneurysm embolism surgery,load dosage before stenting and maintenance dosage for 24 hours of tirofiban were better than load dosage of aspirin combined with clopidogrelbeforestenting in safety,and patients had better neurological function after surgery.

关 键 词：脑动脉瘤 支架辅助栓塞 抗血小板药物 

分 类 号：R743.35[医药卫生—神经病学与精神病学]