替罗非班在颅内破裂宽颈动脉瘤支架辅助弹簧圈栓塞治疗中的安全性及有效性研究  

Safety and efficacy of tirofiban in stent-assisted embolization of ruptured intracranial aneurysms

作　　者：赵秀豪 安昊南 徐淑镇 李军鸿 李树志 于建军 郭锋 Zhao Xiuhao;An Haonan;Xu Shuzhen;Li Junhong;Li Shuzhi;Yu Jianjun;Guo Feng(Department of Neurosurgery,Linyi People's Hospital Affiliated to Weifang Medical College,Linyi 276000,China;Clinical School of Medicine,Weifang Medical College,Weifang 261000,China;Department of Neurosurgery,Gaomi Hospital of Traditional Chinese Medicine,Gaomi 261500,China)

机构地区：[1]潍坊医学院附属临沂市人民医院神经外科,临沂276000 [2]潍坊医学院临床医学院,潍坊261000 [3]高密市中医院神经外科,高密261500

出　　处：《中华神经医学杂志》2023年第6期599-603,共5页Chinese Journal of Neuromedicine

摘　　要：目的探讨静脉注射替罗非班在支架辅助弹簧圈栓塞治疗急性颅内破裂宽颈动脉瘤中的安全性及有效性。方法选择临沂市人民医院神经外科自2020年1月至2022年9月采用支架辅助弹簧圈栓塞治疗的286例急性颅内破裂宽颈动脉瘤患者为研究对象,根据抗血小板治疗方案的不同分为双抗组(术前口服负荷剂量阿司匹林及氯吡格雷,167例)与替罗非班组(术中静脉注射替罗非班,119例)。应用倾向评分匹配对2组患者年龄、性别、Hunt-Hess分级、高血压史、糖尿病史、吸烟史、动脉瘤位置、瘤径、瘤颈比及支架类型进行匹配后,统计分析2组患者围手术期出血性及缺血性并发症发生率、出院时神经功能恢复状况[改良Rankin量表(mRS)评分0~2分为恢复良好]的差异。结果1∶1倾向评分匹配后2组各纳入96例患者进行分析,其中双抗组患者的出血性并发症发生率(2.1%)与替罗非班组(0.0%)的差异无统计学意义(P>0.05),双抗组患者的缺血性并发症发生率(9.3%,包括术中血栓事件8例、术后梗死事件1例)与替罗非班组(7.2%,包括术中血栓事件6例、术后梗死事件1例)的差异无统计学意义(P>0.05),双抗组患者的出院时神经功能恢复良好率(86.4%)与替罗非班组(90.6%)的差异无统计学意义(P>0.05)。结论在急性颅内破裂宽颈动脉瘤支架辅助弹簧圈栓塞治疗中,与术前口服负荷剂量双抗药物相比,术中静脉注射替罗非班的术后近期安全性及有效性相仿。Objective To evaluate the safety and efficacy of intravenous tirofiban in stent-assisted embolization of acute ruptured intracranial aneurysms.Methods A total of 286 patients with acute ruptured intracranial aneurysms who received stent-assisted embolization in Department of Neurosurgery,Linyi People's Hospital from January 2020 to September 2022 were enrolled.According to different preoperative antiplatelet regiments,they were divided into aspirin combined with double resistant group(preoperatively taking orally loading dose of aspirin and clopidogrel,n=167)and tirofiban group(intravenously injecting tirofiban,n=119).Propensity score matching(PSM)was used to adjust for potential differences in age,gender,Hunt-Hess grading,hypertension history,diabetes history,smoking history,aneurysm location,aneurysm neck,aneurysm body-neck ratio,and stent types;incidences of perioperative hemorrhagic and ischemic complications,and neurological recovery status at discharge(scores of modified Rankin scale[mRS]≤2 as good recovery)were compared between the two groups.Results After 1:1 PSM,96 patients were included in each group.No significant difference in incidence of hemorrhagic complications was noted between the double resistant group(2.1%)and tirofiban group(0.0%,P>0.05).No significant difference in incidence of ischemic complications was noted between the double resistant group(9.3%,including 8 with intraoperative thrombosis and 1 with postoperative infarction)and tirofiban group(7.2%,including 6 with intraoperative thrombosis and 1 with postoperative infarction,P>0.05).No significant difference in good recovery rate at discharge was noted between double resistant group(86.4%)and tirofiban group(90.6%,P>0.05).Conclusion In stent-assisted embolization therapy for acute ruptured intracranial aneurysms,preoperative intravenous tirofiban enjoys the same safety and efficacy compared with preoperative oral loading dose of aspirin and clopidogrel.

关 键 词：颅内破裂宽颈动脉瘤 替罗非班 血管内治疗 倾向评分匹配 

分 类 号：R651.12[医药卫生—外科学]