血栓弹力图在支架辅助颅内破裂动脉瘤栓塞术后抗凝治疗中的应用

Application value of thromboelastography in postoperative anticoagulation therapy in intracranial rupture aneurysm embolization assisted by stent

目的:探讨血栓弹力图在支架辅助颅内破裂动脉瘤栓塞病人术后抗凝治疗监测中的应用效果。方法:选取行支架辅助颅内破裂动脉瘤栓塞术病人60例。术前口服双抗负荷量阿司匹林300 mg+氯吡格雷300 mg,行支架辅助栓塞术后静脉使用替罗非班24~36 h,分为对照组30例:常规双抗治疗,即阿司匹林100 mg+氯吡格雷75 mg每天1次;观察组30例:常规双抗治疗后24、48、72 h抽取血标本行血栓弹力图检测花生四烯酸(AA)和二磷酸腺苷(ADP)途径诱导的血小板抑制率检测,根据检测结果调整抗小板药物用量。随访3个月,记录、比较观察组药物调整后血小板抑制率变化情况、2组出血性不良事件及颅内缺血事件发生情况。结果:观察组药物调整后抗凝过度病人的AA、ADP抑制率及低反应性病人的AA抑制率均改善(P<0.05~P<0.01),低反应性病人ADP抑制率差异无统计学意义(P>0.05);观察组出血不良事件及颅内缺血事件发生率均低于对照组(P<0.05)。结论:血栓弹力图可在监测支架辅助颅内动脉瘤栓塞病人术后抗凝治疗中提供参考,指导抗血小板凝集药物剂量调整,可以降低出血性不良事件及颅内缺血事件发生率,改善病人预后。

Objective： To discuss the application effects of thromboelastography（ TEG） in postoperative anticoagulation therapy in intracranial rupture aneurysm embolization assisted by stent. Methods： Sixty patients with rupture intracranial aneurysms treated with stent-assisted embolization were selected. All patients were treated with 300 mg of aspirin and 300 mg of clopidogrel before surgery,stent-assisted for 24 to 36 h,and divided into the control group and observation group（ 30 cases each group）. The control group and observation group were treated with 100 mg of aspirin and 75 mg of clopidogrel by oral one time a day,TEG was used to detect the arachidonic acid（ AA）-and adenosine diphosphate（ ADP）-induced inhibition rate of platelet aggregation in the observation group after24 h,48 h and 72 h after treatment,and the dose of anti-platelet aggregation drugs was adjusted according to the test results. All patients were followed up for 3 months,the change of platelet inhibition rate was observed after adjusting drug dose. The incidence rate of intracranial hemorrhage and ischemia events between two groups were compared. Results： After adjusting drug dose,the platelet inhibition rate in observation group was improved significantly（ P〈0. 05 to P〈0. 01）,and the difference of the low reaction inhibition rate of ADP was not statistically significant（ P〉0. 05）. The incidence rates of intracranial hemorrhage and ischemia in observation group were lower than those in control group（ P〈0. 05）. Conclusions： TEG can provide the reference in monitoring the anti-aplatelet aggregation in patients treated with rupture aneurysm assisted by stent,guide adjusting the dose of anti-platelet aggregation drug to reduce the incidence rate of intracranial hemorrhage and ischemia,and improve the prognosis.