摘要
目的初步探讨应用血栓弹力图(TEG)指导支架辅助栓塞颅内动脉瘤患者围手术期抗血小板治疗的单中心经验.方法回顾性分析2013年1月至2019年12月重庆医科大学附属第一医院神经外科应用支架辅助栓塞颅内动脉瘤治疗的240例患者的临床资料.根据是否行TEG检测将患者分为标准组(58例)与调整组(182例).标准组术后采用标准双联抗血小板聚集治疗(阿司匹林100 mg和氯吡格雷75 mg).调整组的患者采用基于TEG参数调整的抗血小板方案.分析比较两组患者术后围手术期出血或缺血事件的发生率、出院时格拉斯哥预后评级(GOS),以及调整组中发生缺血事件患者与未发生者TEG参数的差异.结果两组患者的年龄、性别、人院时Hunt-Hess分级、吸烟史、饮酒史、糖尿病史、高血压病史、手术时间、是否为破裂动脉瘤、颅内动脉瘤的位置和大小、是否为多发动脉瘤以及置入支架类型的差异均无统计学意义(均P>0.05).调整组出血事件的发生率为0.5%(1/182),低于标准组的6.9%(4/58),差异有统计学意义(P=0.013).调整组缺血事件发生率为23.6%(43/182),与标准组的20.7%(12/58)比较,差异无统计学意义(P>0.05).两组患者出院时GOS均为V级.调整组中,发生缺血事件的患者与未发生者比较,花生四烯酸途径诱导血小板聚集的抑制率、二磷酸腺苷(ADP)途径的抑制率、ADP途径血凝块最大强度分布的差异均无统计学意义(均P>0.05).结论初步观察发现,TEG参数可能有助于识别支架辅助栓塞颅内动脉瘤术后出血风险较高的患者,进而个体化地指导抗血小板治疗.
Objective To preliminarily discuss the single-center experience of using throm-borlastography(TEC)to guide perioperative antiplatelet therapy in patients undergoing stent assisted coiling for the treatment of intracranial aneurysms.Methods A retrospective analysis was conducted on the elinical data of 240 patients with intracranial aneurysms who undervent stent-assisted coiling al Neurosurgery Department,the First Affiliated Hospital of Chongqing Medical University from January 2013 to December 2019.Patients were divided into standard group(58 ceases)and adjustment group(182 cases)according to whether TEG was performed.Patients in the standard group were treated with aspirin 100 mg and clopidogrel 75 mg after surgery.Patients in the adjustment group were treated with an antiplatelet regimen adjusted based on the TEG parameters.We analyzed and compared the ineidence of bleeding or ischemie events during antiplatelet therapy,the score of GOS(Glasgow Outcome Seale)at discharge between the 2 groups.The difference in TEG parameters between patients who developed ischemia and those who did not in the adjustment group was studied as well.Results The age,gender,Hunt-Hess grades at admission,history of smoking,history of alcohol drinking,diabetes,history of hypertension,operation time,whether the aneurysm was ruptured,the location and size of aneurysm,whether there were multiple aneurysms,or the type of stent implanted was not statistically significant between the 2 groups(all P>0.05).The incidence of bleeding events in the adjustment group was 0.5%(1/182).which was lower than that(6.9%,4/58)in the standard group(P=0.013).The incidence of ischemic events in the adjustment group was 23.6%(43/182),which was not significantly different from that(20.7%,12/58)in the standard group(P>0.05).The GOS scores in the 2 groups were both grade V at discharge.In the adjustment group,there was no statistically significant difference in the arachidonie acid inhibition rate,adenosine diphosphate(ADP)inhibition rate,or maximal concentration of ADP distribution between patients who developed ischemia and those who did not(all P>0.05).Conclusion Prdliminary observations have suggested that TEG parameters may be able to help identify patients with a relatively higher risk of bleeding after stent-assisted coiling of intracranial aneurysms,which thus could guide antiplatelet therapy individually.
作者
李袁树
张晓冬
郭宗铎
朱继
徐睿
何朝晖
孙晓川
Li Yiuanshu;Zhang Xiaodong;Guo Zongduo;Zhu Ji;Xu Rui;He Zhaohui;Sun Xiaochuan(Depurtment of Neurosurgery,,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)
出处
《中华神经外科杂志》
CSCD
北大核心
2021年第4期348-353,共6页
Chinese Journal of Neurosurgery
基金
国家自然科学基金(82071332)。
关键词
颅内动脉瘤
血小板聚集抑制剂
手术后并发症
支架辅助栓塞术
血栓弹力图
Intracranial aneurysm
Platelet aggregation inhibitors
Postoperative complications
Stent-assisted coiling
Thromboelastography
作者简介
通信作者:孙晓川,Email:sunxiaochuan@cqmu.edu.cn。
