不同剂量替罗非班联合尼莫地平治疗颅内动脉瘤介入术后疗效观察

Efficacy of Different Doses of Tirofiban Combined with Nimodipine in the Treatment of Patients Undergoing Interventional Surgery for Intracranial Aneurysms

目的探讨不同剂量替罗非班联合尼莫地平治疗颅内动脉瘤介入术后的疗效。方法选取河北省衡水市人民医院2020年1月至2023年1月收治的行颅内动脉瘤介入术患者100例,随机分为A组和B组,各50例。两组患者均予介入治疗、抗凝方案和抗血小板方案。于支架置入后即刻,A组患者静脉注射替罗非班10µg/kg负荷剂量3 min、0.15µg/(kg·min)维持输注(全剂量),B组患者静脉注射替罗非班5µg/kg负荷剂量3 min、0.075µg/(kg·min)维持输注(半剂量),48 h后服用尼莫地平。结果A组和B组缺血性和出血性并发症发生率相当(8.00比6.00%,6.00%比0,P>0.05)。B组术后即刻栓塞程度显著优于A组(P<0.05)。两组患者术前及术后24 h的凝血酶时间、凝血酶原时间、活化部分凝血活酶时间和纤维蛋白原水平比较均无显著差异(P>0.05)。A组与B组患者出院时的临床预后良好率和死亡率相当(78.00%比88.00%,6.00%比2.00%,P>0.05)。A组和B组患者不良反应发生率相当(20%比10.00%,P=0.161>0.05)。结论全剂量和半剂量替罗非班静脉注射联合尼莫地平用于颅内动脉瘤介入术后安全、有效,患者的围术期并发症、凝血指标、预后、不良反应发生率相当,但半剂量替罗非班预防围术期栓塞发生的效果更好。

Objective To investigate the efficacy of different doses of tirofiban combined with nimodipine in the treatment of patients undergoing interventional surgery for intracranial aneurysms.Methods A total of 100 patients who underwent interventional surgery for intracranial aneurysms in the Hengshui People's Hospital from January 2020 to January 2023 were selected and randomly divided into group A and group B,with 50 patients in each group.The patients in the two groups were given interventional therapy,anticoagulant,and antiplatelet regimens.After stent implantation,the patients in group A immediately received full-dose of tirofiban[intravenous injection of tirofiban at a loading dose of 10µg/kg for 3 min,maintained infusion at 0.15µg/(kg·min)],while the patients in group B immediately received half-dose of tirofiban[intravenous injection of tirofibanat a loading dose of 5µg/kg for 3 min,maintained infusion at 0.075µg/(kg·min)].All patients received nimodipine 48 h later.Results The incidence rates of ischemic and hemorrhagic complications in group A were comparable to those in group B(8.00%vs.6.00%,6.00%vs.0,P>0.05).The degree of immediate postoperative embolism in group B was significantly better than that in group A(P<0.05).There was no significant difference in the levels of thrombin time(TT),prothrombin time(PT),activated-partial thromboplastin time(APTT),and fibrinogen(FIB)between the two groups before and 24 h after surgery(P>0.05).The clinical prognosis and mortality rate in group A and group B at discharge were comparable(78.00%vs.88.00%,6.00%vs.2.00%,P>0.05).The incidence of adverse reactions in group A was comparable to that in group B(20.00%vs.10.00%,P=0.161>0.05).Conclusion Intravenous injection of full-dose and half-dose of tirofiban combined with nimodipine is safe and effective in the treatment of patients undergoing interventional surgery for intracranial aneurysms,with comparable incidence of perioperative complications,coagulation indicators,prognosis,and incidence of adverse drug reactions.However,half-dose of tirofiban has a better preventive effect on perioperative embolism.