血栓弹力图在颅内外动脉支架成形术后患者抗血小板治疗中的应用

Applied research of thrombelastograph in antiplatelet therapy to patients with intracranial and extracranial artery stent angioplasty

目的通过应用血栓弹力图监测二磷酸腺苷(ADP)途径诱导的血小板抑制率(简称ADP抑制率),研究颅内外动脉支架成形术患者术后抗血小板治疗的临床疗效。方法选取200例行颅内外动脉支架成形术者,术后常规应用阿司匹林和氯吡格雷双抗治疗,血栓弹力图测定其ADP抑制率,根据抑制率分为3组,抑制率≥70%为反应良好组(设定为A组)96例,抑制率≤30%病例104例,分为2组,每组各52例(分别设定为B、C组),B组保持阿司匹林和氯吡格雷常规剂量治疗不变,C组加大阿司匹林和氯吡格雷剂量,连续随访6个月,记录3组一般情况及严重颅内血管不良事件发生情况。结果 3组患者一般情况比较差异无统计学意义(P>0.05)。随访6个月中,共发生不良事件31例,其中A组8例(8.33%),B组12例(23.08%),C组8例(15.38%),A组不良事件发生率低于B、C组(P<0.05),C组低于B组(P<0.05)。3组病例不良事件的发生在术后1个月较高,但与其他月份间比较差异无统计学意义(P>0.05)。结论血栓弹力图监测在颅内外动脉支架成形术患者抗血小板治疗的过程中,对不良事件发生的预测及抗血小板治疗药物剂量调整有一定的指导意义。

Objective To study clinical efficacy of antiplatelet therapy in intracranial and extracranial carot- id artery stentt patients by monitoring platelet inhibition rate with thrombelastograph. Methods Select 200 cases of intracranial and extracranial carotid artery stent patients treated by our hospital from January 2012 to December 2013, routinely being used double - antibody therapy after surgery. Thrombelastograph measures platelet inhibition rate induced by adenosine diphosphate （ADP）, and divide these cases into three groups according to the inhibition rate. The cases of inhibition rate ≥70% is the qualified group （group A） including 96 cases, the cases of inhibition rate ~〈 30% are divided into two groups, each group includes 52 cases, group B keeps on conventional dose therapy, group C increases the dose. Follow up for six months continually, record general data and adverse events of intracranial vascular adverse events. Result During follow -up of six months ,there were 31 cases of adverse events ,8 cases of group A （8. 33% ）, 12 cases of group B （23.08%） ,8 cases of group C （ 15.38% ）. Incidences of adverse effect in group A was lower than that in group B and C （ P 〈 0.05 ）. That of group C was lower than that of group B （ P 〈 0.05 ）. The occur- rence of adverse events in three groups was higher at one month and six months after surgery. Conclusion Throm- belastograph monitors the process of antiplatelet therapy to intracranial and extracranial artery stenting patients, it has certain leading significance to the prediction of adverse events and dose adjustment of antiplatelet drugs.