[1]许晓川　李志清　高　旭　王晓刚　梁国标.动脉局部应用替罗非班治疗颅内动脉瘤介入术中急性血栓形成的临床分析[J].中国临床神经外科杂志,2020,(11):740-742.[doi:doi:10.13798/j.issn.1009-153X.2020.11.002]
　XU Xiao-chuan,LI Zhi-qing,GAO Xu,et al.Topical intra-arterial infusion of tirofiban for treatment of acute thromboembolism during embolization of intracranial aneurysms[J].,2020,(11):740-742.[doi:doi:10.13798/j.issn.1009-153X.2020.11.002]
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动脉局部应用替罗非班治疗颅内动脉瘤介入术中急性血栓形成的临床分析()
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《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
期数:
2020年11期
页码:
740-742
栏目:
论著
出版日期:
2020-11-25

文章信息/Info

Title:
Topical intra-arterial infusion of tirofiban for treatment of acute thromboembolism during embolization of intracranial aneurysms
文章编号:
1009-153X（2020）11-0740-03
作者:
许晓川　李志清　高　旭　王晓刚　梁国标
110840 沈阳，国人民解放军北部战区总医院神经外科（许晓川、高　旭、王晓刚、梁国标）；110004 沈阳，中国医科大学附属盛京医院神经外科（李志清）
Author(s):
XU Xiao-chuan1;  LI Zhi-qing2;  GAO Xu1;  WANG Xiao-gang1;  LIANG Guo-biao1.
1. Department of Neurosurgery, General Hospital of Northern Theater Command, PLA, Shenyang 110840, China; 2. Department of Neurosurgery, Shengjing Hospital of Capital Medical University, Shenyang 110004, China
关键词:
颅内破裂动脉瘤; 血管内栓塞; 术中血栓形成; 替罗非班; 动脉局部应用
Keywords:
Intracranial aneurysm;  Embolization;  Acute thromboembolism;  Tirofiban;  Topical intra-arterial infusion
分类号:
R 743.9; R 815.2
DOI:
doi:10.13798/j.issn.1009-153X.2020.11.002
文献标志码:
A
摘要:
目的 探讨动脉局部应用盐酸替罗非班治疗颅内动脉瘤介入术中急性血栓形成的有效性及安全性。方法 回顾性分析2018年2月至2019年6月栓塞治疗551例颅内动脉瘤的临床资料。对于术中进行血栓形成，在动脉瘤致密填塞后，经微导管局部灌注盐酸替罗非班0.5~1.25 mg。结果 551例中，20例出现急性血栓形成，其中13例术中即出现，7例术后0.5~3 h内出现症状行DSA发现动脉闭塞。20例均实现完全血运重建，TICI分级3级；其中16例恢复良好，4例出现不同程度的神经功能障碍；出院后随访2~18个月，平均10.7个月；16例无新增出血及并发症；1例神经功能障碍恢复正常，3例神经功能障碍有不同程度好转。结论 盐酸替罗非班经动脉局部应用对治疗颅内破裂动脉瘤栓塞术中急性血栓形成安全、有效。
Abstract:
Objective To investigate the efficacy and safety of topical intra-arterial infusion of tirofiban for treatment of acute thromboembolism during the embolization of intracranial aneurysms. Methods The clinical data of 551 patients with intracranial aneurysm who received endovascular embolization from February 2018 to June 2019 were retrospectively analyzed. For the patients who had acute thromboembolism, the tirofiban (0.5~1.25 mg) was topical infused to the artery through a micro-catheter after dense embolization of the aneurysmal body. Results Of 551 patients with intracranial aneurysm, 20 patients had acute thromboembolism, 13 patients of whom developed acute thromboembolism during the operation and 7 within 0.5 to 3 hours after the operation. The complete revascularization and TICI grade 3 were achieved in 20 patients, 16 patients of whom were recovered well and 4 left neurological dysfunction in different degrees. All the patients were followed up for 2~18 months, with an average of 10.7 months. Sixteen patiensts had no new bleeding or complications, 1 patient with neurological dysfunction was returned to normal, and 3 with neurological dysfunction were improved. Conclusion After dense embolization of the aneurysmal body, topical infusion of tirofiban is a safe and effctive method for treatment of acute thromboembolism during the embolization of intracranial aneurysms.

参考文献/References:

[1] Workman MJ, Cloft HJ, Tong FC, et al. Thrombus formation at the neck of cerebral aneurysms during treatment with Guglielmi detachable coils [J]. Am J Neuroradiol, 2002, 23: 1568-1576.
[2] 李　捷，龙霄翱，李丽球，等. 超选择注射替罗非班治疗颅内动脉瘤栓塞术中急性血栓形成的临床疗效[J]. 卒中与神经疾病，2019，26（1）：57-61.
[3] 赵香梅，高传玉，张　宾，等. 替罗非班对急性心肌梗死患者高水平血小板聚集率和预后的影响[J]. 中国实用医刊，2010，37（ 4）：145-148.
[4] 梁晓东，王子亮，李天晓，等. 盐酸替罗非班在颅内动脉瘤介入治疗中的应用进展[J]. 中华介入放射学电子杂志，2016，4（1）：44-47.
[5] Amaral-Silva A, Pineiro S, Molina CA. Sonothrombolysis forthe treatment of acute stroke: current concepts and future directions [J]. Expert Rev Neurother, 2011, 11(2): 265-273.
[6] 廖旭兴，钟伟健，董安石，等. 替罗非班在颅内破裂动脉瘤急性期支架辅助弹簧圈栓塞中的应用[J]. 中国临床神经外科杂志，2019，24（11）：672-674.
[7] 李曦铭，柴仁贵，丛洪良，等. 替罗非班对急性心肌梗死再灌注模型猪的梗死区微血管的保护作用[J]. 中华老年医学杂志，2012，31：63-67.
[8] 刘　明，李永奇，李　凯，等. 替罗非班用于治疗颅内动脉瘤栓塞期间的血栓栓塞的临床疗效观察[J]. 中南医学科学杂志， 2019（5）：527-530.
[9] 冯　雷，潘　力，冯　光，等. 替罗非班联合尿激酶超选择动脉溶栓治疗急性大脑中动脉栓塞的实验研究[J]. 天津医药，2011，39（12）：1150-1152.
[10] Huxtable LM, Mohammad JT, Rakkar AS. Frequency and management of thrombocytopenia with the glycoprotein Ⅱb/Ⅲa receptor antagonists [J]. Am J Cardiol, 2006, 97: 426-429.

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更新日期/Last Update: 2020-11-25