脑膜瘤术后抗凝治疗与颅内出血和血栓栓塞并发症的关系  

Relationship between postoperative anticoagulant treatment and postoperative intracranial hemorrhage and thromboembolic events in patients with meningiomas

作　　者：詹艳 杨媛 马严菊 马俊 ZHAN Yan;YANG Yuan;MA Yan-ju;MA Jun(Department of Neurosurgery,Lu'an Hospital Affiliated to Anhui Medical University(Lu'an People's Hospital),Lu'an 237000,China)

机构地区：[1]安徽医科大学附属六安医院(六安市人民医院)神经外科,安徽六安237000

出　　处：《中国临床神经外科杂志》2023年第10期628-631,共4页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨脑膜瘤术后抗凝治疗(AC)与颅内出血(PH)和血栓栓塞(TE)并发症的关系。方法回顾性分析2016年1月至2022年12月手术治疗的271例脑膜瘤的临床资料。主要终点为颅内出血和血栓栓塞(包括肠系膜栓塞、肺栓塞、深静脉血栓形成、脑梗塞、心肌梗塞);次要终点为术后30 d死亡,采用改良Rankin量表(mRS)评分评估临床预后。结果11例(4.05%)术后发生血栓栓塞,中位时间为术后11.17(IQR:3.71~16.79)d;其中7例为肺栓塞,4例为深静脉血栓形成。16例(5.90%)术后发生颅内出血,中位时间为术后18.50(IQR:4~64)h,其中13例发生在术后24 h内,3例在服用抗凝剂后CT扫描发现出血。多因素logistic回归分析显示抗凝治疗启动时间延迟脑膜瘤术发生血栓栓塞、颅内出血的独立危险因素(P<0.05)。11例血栓栓塞中,8例(72.73%)mRS评分3~6分,16例颅内出血中,7例(43.75%)mRS评分3~6分。4例死亡,其中2例死于肺栓塞,1例颅内出血并脓毒性休克病人放弃治疗后死亡,1例颅内出血死于不明原因的脑梗死。结论脑膜瘤术后延迟抗凝治疗会增加颅内出血、血栓栓塞的风险。而血栓栓塞对预后的影响大于颅内出血,因此建议脑膜瘤术后早期启动预防性抗凝治疗。Objective To investigate the relationship between postoperative anticoagulant therapy(AC)and postoperative intracranial hemorrhage(ICH)and thromboembolic events(TE)in patients with meningionmas.Methods The clinical data of 271 patients with meningiomas underwent microsurgery from January 2016 to December 2022 were retrospectively analyzed.The primary end points were postoperative ICH and TE(including mesenteric embolism,pulmonary embolism,deep vein thrombosis,cerebral infarction,myocardial infarction).The secondary endpoint was death at 30 days after surgery,and the clinical outcome was assessed using the modified Rankin Scale(mRS)score.Results Eleven patients(4.05%;7 pulmonary embolism and 4 deep vein thrombosis)suffered from TE,and the median time of occurrence was 11.17(IQR:3.71~16.79)days.ICH occurred in 16 patients(5.90%);the median time was 18.50(IQR:4~64)h after surgery;13 patients occurred within 24 h after surgery and 3 were found bleeding by CT scan after AC therapy.Multivariate logistic regression analysis showed that delayed AC therapy was an independent risk factor for ICH and TE(P<0.05).Of 11 patients with TE,8 patients(72.73%)had a mRS score of 3~6.Of 16 patients with ICH,7 patients(43.75%)had a mRS score of 3~6.Four patients died,of whom 2 died of pulmonary embolism,1 died of ICH and septic shock after abandoning treatment,and 1 died of cerebral infarction of unknown cause.Conclusions Delayed AC therapy may increase the risk of ICH and TE in patients with meningiomas after operation.TE has a greater impact than ICH on prognosis of patients with meningiomas,so it is recommended to start preventive AC therapy early after surgery.

关 键 词：脑膜瘤 显微手术 抗凝治疗 术后出血 术后血栓栓塞 

分 类 号：R739.45[医药卫生—肿瘤]