替罗非班在破裂颅内宽颈动脉瘤急性期支架辅助栓塞围手术期的应用研究

Perioperative administration of tirofiban for stent-assisted coiling of intracranial ruptured wide-neck aneurysm in acute period

目的:观察替罗非班在破裂颅内宽颈动脉瘤急性期支架辅助栓塞围手术期应用的效果和安全性。方法:将2014年1月至2015年5月采用支架辅助微弹簧圈栓塞治疗破裂颅内宽颈动脉瘤急性期18例患者均分为替罗非班大剂量组及小剂量组。术中两组均给予替罗非班10μg·kg^(-1),3 min内静脉推注,再以0.15μg·kg^(-1)·min^(-1)持续静脉泵入。大剂量组术后继续维持0.15μg·kg^(-1)·min^(-1)静脉泵入12 h,然后停用;小剂量组术后改为0.10μg·kg^(-1)·min^(-1)持续静脉泵入12 h,然后降为0.05μg·kg^(-1)·min^(-1),再持续泵入12~36 h后停用。两组术后12 h均鼻饲阿司匹林100 mg和氯吡格雷75 mg。结果:18例21个动脉瘤,其中破裂宽颈动脉瘤18个,均采用支架辅助微弹簧圈栓塞治疗。术中出现急性支架内血栓形成2例,均经微导管行载瘤动脉内注射替罗非班3~5 ml(150~250μg,静脉推注,3 min)后恢复再通。所有病例术后均未发生迟发性梗塞及颅内出血并发症。两种替罗非班给药方式均可达到药物疗效,而小剂量组发生皮肤黏膜和穿刺点出血更少。结论:替罗非班用于破裂颅内宽颈动脉瘤急性期介入栓塞围手术期患者可能是安全有效的。

Objective： To study the effect and safety of tirofiban administration for stent-assisted coiling of intracranial ruptured wide-neck aneurysm in acute period. Methods： Eighteen cases of stent-assisted coiling of intracranial ruptured wide-neck aneurysm in acute period were enrolled in the study and they were randomly divided into two groups, i. e. , high dose and low dose group. A load dose of tirofiban was intravenously administrated in both groups（10 μg ·kg-1 ,injection in 3 min） followed by a maintenance dose（0. 15 μg· kg-1· min-1） during the operation. The maintenance dose（0. 15 μg·kg-1· min-1 ） of tirofiban lasted for 12 hours in the high dose group postoperation and then was stopped. In the low dose group,the maintenance dose（0. 10 μg · kg-1· min-1） lasted for 12 hours and then was decreased to 0. 05 μg · kg-1 · min-1 lasting for 12 to 36 hours. Aspirin（ 100 mg）and clopidorel（75 mg） were used by nasal feeding in both groups 12 hours after the operation. Results： Eighteencases with 21 aneurysms,including 18 ruptured wide-neck aneurysms,were treated by stent-assisted coiling. Theintraoperative in-stent thrombosis was observed in 2 cases, and they were recanalized by intraarterial injection of tirofiban with 3 to 5 ml （150-250 μg, iv,3 min）. Delayed cerebral infarction and intracranial hemorrhagecomplications did not appear in all cases. Conclusion： The use of tirofiban in acute period of intracranial ruptured wide-neck aneurysm treated by stent-assisted coiling may be efficient and safe.