颅内破裂囊性动脉瘤介入治疗围手术期应用替罗非班的安全性及可行性研究  

Safety and feasibility of tirofiban used for intracranial ruptured cystic aneurysms during perioperative interventional treatment

作　　者：吕超 鲁传豪 张力 邵晓东 曹妍 王娟 李侠 Lyu Chao;Lu Chuanhao;Zhang Li;Shao Xiaodong;Cao Yan;Wang Juan;Li Xia(Department of Neurosurgery,First Affiliated Hospital of Air Force Medical University,Xi′an 710032,China)

机构地区：[1]空军军医大学第一附属医院神经外科,西安710032 [2]西安航天总医院神经外科

出　　处：《中国脑血管病杂志》2022年第8期524-531,共8页Chinese Journal of Cerebrovascular Diseases

基　　金：陕西省创新能力支撑计划项目(2022TD-42)。

摘　　要：目的评价替罗非班用于颅内破裂囊性动脉瘤介入围手术期抗血小板聚集治疗的安全性和有效性。方法回顾性连续纳入2014年1月至2021年1月空军军医大学第一附属医院神经外科在颅内囊性动脉瘤破裂急性期接受球囊和(或)支架辅助技术进行介入治疗患者267例。依据急诊介入治疗术中是否使用替罗非班作为抗血小板聚集治疗的应急方案,将267例患者分为替罗非班组(112例)和负荷双抗(阿司匹林300 mg+氯吡格雷300 mg)组(155例)。记录并比较两组患者的一般资料(性别、年龄、高血压病、术前血小板计数)、动脉瘤特征[部位、数量、瘤体最大径、宽颈、蛛网膜下腔出血严重程度(Hunt-Hess分级Ⅰ~Ⅴ级)]、手术时长、栓塞效果、围手术期出血和缺血事件、出院时改良Rankin量表(mRS)评分。围手术期抗血小板聚集治疗的有效性评价指标为术中缺血事件(Enterprise支架内血栓形成、排除血管痉挛情况后的载瘤动脉血流延缓或血管不显影)、术后即刻栓塞效果(以Raymond分级Ⅰ~Ⅱ级为有效)、出院时神经功能恢复情况(mRS评分0~2分为预后良好,3~5分为预后不良,6分为死亡);其安全性评价指标为术中出血事件(动脉瘤二次破裂)及术后72 h内缺血事件(经头部CT证实的新发脑梗死)、出血事件(颅内出血增加和颅外出血事件)。颅内出血增加主要指与术前头部CT结果对比后证实蛛网膜下腔或脑实质内出血增加,颅外出血事件包括鼻衄、牙龈出血、肉眼血尿、皮肤点状出血或瘀斑、腹股沟血肿、腹膜后血肿、消化道出血。结果(1)两组患者性别、高血压病比例以及年龄、术前血小板计数水平的差异均无统计学意义(均P>0.05)。两组患者宽颈、位于前循环、多发、Hunt-Hess分级Ⅰ~Ⅱ级动脉瘤比例的差异均无统计学意义(均P>0.05)。(2)两组患者平均手术时间、术中缺血事件发生率的差异均无统计学意义(�Objective To evaluate the efficacy and safety of tirofiban in perioperative antiplatelet aggregation therapy for intracranial ruptured cystic aneurysms.Methods All 267 patients were retrospectively included,who with intracranial ruptured cystic aneurysms treated by balloon and(or)stent-assisted coils embolization in the acute stage in the Department of Neurosurgery of the First Affiliated Hospital of Air Force Military Medical University from January 2014 to January 2021.According to whether tirofiban was used as an emergency plan for antiplatelet aggregation therapy during interventional therapy,267 patients were divided into tirofiban group(112 cases)and loading-dose dual-antiplatelet group(155 cases;Aspirin 300 mg+clopidogrel 300 mg).The general data(gender,age,hypertension,preoperative platelet count),characteristics of aneurysms(location,number,maximum diameter of aneurysm,wide neck,severity of subarachnoid hemorrhage[Hunt-Hess gradeⅠ-Ⅴ]),time duration of operation,embolization effect,perioperative bleeding and ischemic events,and modified Rankin Scale(mRS)score at discharge were recorded and compared between the two groups.The effectiveness evaluation indicators of perioperative antiplatelet aggregation therapy are intraoperative ischemic events(thrombosis in the Enterprise stent,delayed or non-blood flow in the aneurysm parent artery after excluding vessels vasospasm),immediate embolization effect post-operation(Raymond gradeⅠ-Ⅱconsidered as effective),neurological recovery at discharge(mRS score 0-2 is considered as good prognosis,3-5 as poor prognosis,and 6 as death).The safety evaluation indicators were intraoperative hemorrhagic events(secondary rupture of aneurysms)and ischemic events within 72 hours post-operation(new cerebral infarction confirmed by head CT),hemorrhagic events(intracranial hemorrhage and extracranial hemorrhage events).The increase of intracranial hemorrhage was determined by two attending physicians depending on the CT images pre-and post-operation.Extracranial bleeding eve

关 键 词：颅内动脉瘤 血小板聚集抑制剂 替罗非班 介入治疗 手术中并发症 

分 类 号：R743[医药卫生—神经病学与精神病学]