有症状大脑中动脉狭窄患者支架置入术后依诺肝素对亚急性支架内血栓形成的影响  

Effect of enoxaparin on subacute in-stent thrombosis after stenting in patients with symptomatic middle cerebral artery stenosis

作　　者：马莉[1] 李敬伟 Ma Li;Li Jingwei(Drum Tower Clinical Medical School,Nanjing University of Chinese Medicine,Nanjing 210008,China;Department of Neurology,Nanjing Drum Tower Hospital,Nanjing 210008,China)

机构地区：[1]南京中医药大学鼓楼临床医学院神经内科,南京210008 [2]南京鼓楼医院神经内科,南京210008

出　　处：《国际脑血管病杂志》2023年第11期824-829,共6页International Journal of Cerebrovascular Diseases

摘　　要：目的探讨有症状大脑中动脉狭窄患者支架置入术后使用依诺肝素能否降低亚急性支架内血栓形成(in-stent thrombosis,IST)风险。方法回顾性纳入2020年1月至2022年12月在南京中医药大学鼓楼临床医学院神经内科接受支架置入术的有症状大脑中动脉狭窄患者。根据术后是否使用依诺肝素将患者分为依诺肝素组和对照组。比较两组人口统计学和基线资料以及围手术期并发症发生率。应用多变量logistic分析确定术后亚急性IST的独立影响因素。结果共纳入86例患者,男性61例(70.93%),年龄(58.03±10.14)岁;48例(55.81%)使用了依诺肝素。依诺肝素组亚急性IST发生率显著低于对照组(2.08%对13.16%;χ^(2)=4.008,P=0.045),而有症状颅内出血发生率与对照组差异无统计学意义(2.08%对2.63%;χ^(2)=0.028,P=0.867)。多变量logistic回归分析显示,支架置入术后使用依诺肝素为亚急性IST的独立保护因素(优势比0.042,95%置信区间0.005~0.901;P=0.042)。结论有症状大脑中动脉狭窄患者支架置入术后使用依诺肝素可降低亚急性IST发生率,且不会增高有症状颅内出血发生率。Objective To investigate whether the use of enoxaparin after stenting in patients with symptomatic middle cerebral artery stenosis can reduce the risk of subacute in-stent thrombosis(IST).Methods Patients with symptomatic middle cerebral artery stenosis underwent stenting in the Department of Neurology,Drum Tower Clinical Medical School,Nanjing University of Chinese Medicine from January 2020 to December 2022 were retrospectively included.The patients were divided into an enoxaparin group and a control group based on whether to use enoxaparin after surgery.The demographic and baseline data and the incidence of perioperative complications were compared between the two groups.Multivariate logistic analysis was used to determine the independent influencing factors of postoperative subacute IST.Results A total of 86 patients were enrolled,including 61 males(70.93%),and aged 58.03±10.14 years old.Forty-eight patients(55.81%)were treated with enoxaparin.The incidence of subacute IST in the enoxaparin group was significantly lower than that in the control group(2.08%vs.13.16%;χ^(2)=4.008,P=0.045),and there was no statistically significant difference in the incidence of symptomatic intracranial hemorrhage compared to the control group(2.08%vs.2.63%;χ^(2)=0.028,P=0.867).Multivariate logistic regression analysis showed that the use of enoxaparin after stenting was an independent protective factor of subacute IST(odds ratio 0.042,95%confidence interval 0.005-0.901;P=0.042).Conclusion The use of enoxaparin after stenting in patients with symptomatic middle cerebral artery stenosis can reduce the incidence of subacute IST without increasing the incidence of symptomatic intracranial hemorrhage.

关 键 词：颅内动脉硬化 大脑中动脉 缩窄 病理性 支架 依诺肝素 血栓形成 

分 类 号：R743[医药卫生—神经病学与精神病学]