支架辅助栓塞破裂动脉瘤抗血小板聚集方案比较  

A Comparative Study of the Antiplatelet Protocols for Stent-assisted Coiling of Ruptured Intracranial Aneurysms

作　　者：王磊 黄建煌[1] 陈建宁[1] 黄迢华[1] 宋建华[1] 姚正健[1] WANG Lei;HUANG Jianhuang;CHEN Jianning;HUANG Tiaohua;SONG Jianhua;YAO Zhengjian(Department of Neurosurgery,The Affiliated Hospital of Putian University,Putian Fujian 351100,China)

机构地区：[1]莆田学院附属医院神经外科,福建莆田351100

出　　处：《莆田学院学报》2022年第2期66-70,85,共6页Journal of putian University

摘　　要：将采用支架辅助弹簧圈栓塞治疗的破裂颅内动脉瘤患者,按照围手术期抗血小板聚集方案不同,分为双抗负荷组、替罗非班常规剂量组和小剂量组,通过比较3组患者围手术期并发症发生率,分析3种方案的疗效与安全性。结果显示,双抗负荷组、替罗非班常规剂量组和小剂量组出血事件发生率分别为6.7%(3/45)、11.1%(8/72)、0.0%,组间比较差异有统计学意义(P<0.05),其中替罗非班小剂量组出血事件发生率低于常规剂量组(P<0.01),双抗负荷组与替罗非班常规剂量组、小剂量组比较差异均无统计学意义(P值均>0.05)。结果表明:在支架辅助栓塞破裂颅内动脉瘤围手术期抗血小板聚集方案中,替罗非班是负荷剂量双抗安全而有效的替代方案;其中采用常规剂量替罗非班出血风险较高,通过减少药物剂量有助于降低该风险。The patients who underwent stent-assisted coiling(SAC)for acutely ruptured intracranial aneurysms are divided into three groups based on antiplatelet protocols,including the loading-dose dual antiplatelet(DAP)group,the tirofiban usual-dose group and the half-dose group.The safety and efficacy of the antiplatelet protocols are analyzed by comparing the rates of complications during the perioperative period.The results show that the rates of hemorrhagic complications are 6.7%(3/45),11.1%(8/72)and 0.0%respectively in those three groups with a statistical difference of P<0.05.The rate of hemorrhagic complications of the tirofiban half-dose group is significantly lower than that of the usual-dose group(P<0.01),while there is no statistical difference between the loading-dose DAP group and the tirofiban half-dose group(P=0.527)or between the loading-dose DAP group and the usual-dose group(P=0.085).As a perioperative antiplatelet prophylaxis for SAC of acutely ruptured intracranial aneurysms,intravenous tirofiban proves an effective alternative to oral loading-dose DAP.The application of usual-dose tirofiban shows a higher incidence of hemorrhage,which can be decreased by reducing tirofiban dose.

关 键 词：颅内动脉瘤 血小板聚集抑制剂 支架 出血 血栓栓塞 

分 类 号：R651.12[医药卫生—外科学]