围术期不同抗血小板方案在颅内未破裂动脉瘤介入术患者中的临床疗效及出血性风险比较

Application of Different Perioperative Antiplatelet Regimens in Patients with Unruptured In- tracranial Aneurysms Treated by Interventional Therapy and Comparison of the Risks of Bleed-ing after Operation

【目的】探讨围术期不同抗血小板方案治疗颅内未破裂动脉瘤介入术患者临床疗效及出血风险比较。【方法】回顾性分析2012年2月至2016年10月本院收治的160例颅内未破裂动脉瘤行介入术治疗的患者的临床资料，根据治疗方法不同将其分为A纽[术中给予负荷剂量（8ug／kg）替罗非班治疗，3min后改为维持剂量（0．1μg／kg·min）治疗，n=50]、B组（术前2～24h给予负荷剂量氯吡格雷治疗，n=60）、C组（术前3～5d给予75mg氯吡格雷＋100mg阿司匹林治疗，n=50），观察三组术后出血事件及血栓栓塞事件发生率、并发症发生率、格拉斯哥昏迷指数（GOS）评分变化及半年后随访预后情况。【结果】术后A组出血事件及血栓栓塞事件发生率显著低于B组、c组，差异有统计学意义（均P〈O．05）；而B组与c组出血事件及血栓栓塞事件发生率比较，差异无统计学意义（P〉0．05）。术后A组并发症发生率显著低于B组、C组，差异有统计学意义（P〈0．05）；B组与C组并发症发生率比较，差异无统计学意义（P〉0．05）。治疗前，三组GOS评分比较，差异无统计学意义（P〉O．05）；术后1个月、术后2个月、术后3个月三组GOS评分显著高于治疗前，且A组GOS评分显著高于B组、c组，差异均具有统计学意义（P〈0．05）。A组随访率为1∞％（50／50），B组随访率98．33（59／60），C组随访率96．00（48／50），随访结果显示A组预后效果显著优于B组、C组，差异具有统计学意义（Pd0．05）。【结论】替罗非班治疗方案可作为一种治疗颅内未破裂动脉瘤介入术患者安全有效的抗血小板方案，其较双抗抗血小板方案及负荷剂量氯吡格雷治疗方案更具优势，且出血风险更低。

[Objective]To investigate the application of different perioperative antiplatelet regimens in pa- tients with unruptured intracraniai aneuryms treated by interventional therapy and compare the risks of bleed- ing. [Methods]A total of 160 cases of patients with unruptured intracranial aneurysms treated by intervention- al therapy in our hospital from February 2012 to October 2016 were enrolled in the study. According to the dif ferent treatment methods, the patients were divided into A group [treated with loading dose （8lzg/kg） of tiro fiban for 3 min, followed by the maintenance dose （0.1μg/kg·min）, n =50], B group （treated with loading dose of clopidogrel at 2h-24h before operation, n = 60） and C group （treated with 75rag of clopidogrel and 100rag of Bayaspirin at 3-5d before operation, n =50）. We observed the incidence of bleeding and tbrombo- embolic events, the occurrence of complications, changes of Glasgow Coma Scale （GOS） scores, and follow- up results.[Results]After operation, the incidence rates of bleeding events, thromboembolic events and corn plications were significantly lower in A group than B group and C group. The prognosis of A group was signifi- cantly better than that of B group and C group （ P 〈0.05）. However, there were no statistically significant differences between B group and C group in the incidence rates of bleeding events, thromboembolic events and complications and the prognosis （ P 〉0.05）. There were no significant differences in GOS scores among the three groups before treatment（ P 〈0.05）. At 1 month, 2 months and 3 months after operation, the GOS scores of the three groups were significantly higher, and the increase was more obvious in A group than B group and C group （ P %0.05）. However, there was no significant difference between B group and C group（ P 〈0.05）. The follow up rate was 100% （50/50） in group A, 98.33 （59/60） in group B, and 96.00 （48/ 50） in group C. The follow-up results showed that the prognosis of group A was significantly better than group B and group C ; the difference was statistically significant （ P 〈0.05）.[ConelusionlTirofiban regimen can be used as a safe and effective antiplatelet treatment for patients with unruptured intracranial aneurysms treated by interventional therapy. Compared with dual antiplatelet regimen and loading dose of clopidogrel regimen, it has more advantages, and the risks of bleeding are lower.