颅内动脉瘤支架联合弹簧圈栓塞术后差异性双联抗血小板维持时间对迟发性脑缺血的作用效果比较  

Comparison of differential dual antiplatelet maintenance time after intracranial aneurysm stent combined with coil embolization on delayed cerebral ischemia

作　　者：詹世钦 赵万里 覃波 ZHAN Shi-qin;ZHAO Wan-li;QIN Bo(Department of Neurosurgery,Songgang People’s Hospital,Shenzhen 518105,Guangdong,China)

机构地区：[1]深圳市宝安区松岗人民医院神经外科,广东深圳518105

出　　处：《生物医学工程与临床》2023年第2期201-205,共5页Biomedical Engineering and Clinical Medicine

摘　　要：目的 研究对比颅内动脉瘤支架联合弹簧圈栓塞术后差异性双联抗血小板维持时间对迟发性脑缺血的作用效果。方法 选择接受颅内动脉瘤支架联合弹簧圈栓塞术治疗的203例患者,其中男性84例,女性119例;年龄25~75岁,平均年龄52.18岁;病灶部位,大脑前动脉9例,颈内动脉163例,后循环23例,大脑中动脉8例;病灶直径2~20 mm,平均病灶直径13.21 mm;动脉瘤数量,单发72例,多发131例。所有患者术后均开展双联抗血小板治疗,将其按照双联抗血小板维持时间的差异分作短期组(治疗持续时间3个月)68例,中期组(治疗持续时间6个月)75例,长期组(治疗持续时间9个月)60例。分析3组各项手术情况(主要涵盖支架长度、Raymond分级、术中并发症),迟发性脑缺血发生情况[主要包括短暂性脑缺血发作(TIA)和脑梗死],不良反应发生情况(主要涵盖恶心呕吐、消化道反应、肝肾功能损害、过敏反应)等方面的差异。结果 3组在支架长度、Raymond分级和术中并发症方面对比,差异均无统计学意义(均P> 0.05)。短期组中TIA 2例,脑梗死4例,迟发性脑缺血总发生率8.82%(6/68);中期组中TIA 3例,脑梗死2例,迟发性脑缺血总发生率6.67%(5/75);长期组中TIA 0例,脑梗死0例,迟发性脑缺血总发生率0.00%。长期组迟发性脑缺血总发生率低于短期组和中期组(均P <0.05)。3组恶心呕吐、消化道反应、肝肾功能损害和过敏反应发生率对比,差异均无统计学意义(均P> 0.05)。结论 颅内动脉瘤支架联合弹簧圈栓塞术后进行9个月以上的双联抗血小板治疗可明显降低迟发性脑缺血发生风险,且不会增加不良反应发生风险,值得临床推广应用。Objective To study and compare the effects of different dual antiplatelet maintenance time on delayed cerebral ischemia after intracranial aneurysm stent combined with coils embolization. Methods A total of 203 patients performed intracranial aneurysm stent combined with coil embolization were enrolled, which included 84 males and 119 females, aged 25-75 years old with mean age of 52.18 years old. The lesions were located at anterior cerebral artery in 9 cases, internal carotid artery in 163 cases, posterior circulation in 23 cases, and middle cerebral artery in 8 cases. The lesion diameter was 2-20 mm with mean diameter of 13.21 mm. There were 72 cases of single aneurysm and 131 cases of multiple aneurysms. All of them were treated with dual antiplatelet therapy, and divided into short-term group( n = 68, treatment 3-month) and mid-term group(n = 75, treatment 6-month) and long-term group(n = 60, treatment 9-month) according to dual antiplatelet maintenance time difference. The various surgical conditions(stent length, Raymond grade, intraoperative complications), delayed cerebral ischemia occurrences [ transient ischemic attack( TIA) and cerebral infarction ], adverse reactions( nausea and vomiting,gastrointestinal reactions, liver and kidney dysfunction, allergic reactions) and other differences in 3 groups were analyzed.Results There were no significant differences in stent length, Raymond grading and intraoperative complications in 3 groups(P > 0.05). In short-term group, there were 2 cases of TIA and 4 of cerebral infarction, and total incidence of delayed cerebral ischemia was 8.82 %(6/68). In mid-term group, there were 3 cases of TIA and 2 of cerebral infarction, and total incidence of delayed cerebral ischemia was 6.67 %(5/75). In long-term group, there were 0 case of TIA and cerebral infarction, the total incidence of delayed cerebral ischemia was 0.00 %. The total incidence of delayed cerebral ischemia in long-term group was lower than that in short-term group and mid-term group(P < 0.05). There were n

关 键 词：颅内动脉瘤 支架 弹簧圈栓塞术 双联抗血小板 迟发性脑缺血 不良反应 

分 类 号：R743.31[医药卫生—神经病学与精神病学]