[1]詹艳,杨媛,马严菊,等.脑膜瘤术后抗凝治疗与颅内出血和血栓栓塞并发症的关系[J].中国临床神经外科杂志,2023,28(10):628-631.[doi:10.13798/j.issn.1009-153X.2023.10.006]
　ZHAN Yan,YANG Yuan,MA Yan-ju,et al.Relationship between postoperative anticoagulant treatment and postoperative intracranial hemorrhage and thromboembolic events in patients with meningiomas[J].,2023,28(10):628-631.[doi:10.13798/j.issn.1009-153X.2023.10.006]
点击复制

脑膜瘤术后抗凝治疗与颅内出血和血栓栓塞并发症的关系()
分享到：

《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
28
期数:
2023年10期
页码:
628-631
栏目:
论著
出版日期:
2023-10-31

文章信息/Info

Title:
Relationship between postoperative anticoagulant treatment and postoperative intracranial hemorrhage and thromboembolic events in patients with meningiomas
文章编号:
1009-153X（2023）10-0628-04
作者:
詹艳; 杨媛; 马严菊; 马俊
237000安徽六安，安徽医科大学附属六安医院（六安市人民医院）神经外科（詹艳、杨媛、马严菊、马俊）
Author(s):
ZHAN Yan;  YANG Yuan;  MA Yan-ju;  MA Jun
Department of Neurosurgery, Lu'an Hospital Affiliated to Anhui Medical University (Lu'an People's Hospital), Lu'an 237000, China
关键词:
脑膜瘤; 显微手术; 抗凝治疗; 术后出血; 术后血栓栓塞
Keywords:
Meningiomas;  Microsurgery;  Anticoagulatant thearpy;  Postoperative intracranial hemorrhage;  Thromboembolic events
分类号:
R 739.41; R 651.1+1
DOI:
10.13798/j.issn.1009-153X.2023.10.006
文献标志码:
A
摘要:
目的 探讨脑膜瘤术后抗凝治疗（AC）与颅内出血（PH）和血栓栓塞（TE）并发症的关系。方法 回顾性分析2016年1月至2022年12月手术治疗的271例脑膜瘤的临床资料。主要终点为颅内出血和血栓栓塞（包括肠系膜栓塞、肺栓塞、深静脉血栓形成、脑梗塞、心肌梗塞）；次要终点为术后30 d死亡，采用改良Rankin量表（mRS）评分评估临床预后。结果 11例（4.05%）术后发生血栓栓塞，中位时间为术后11.17（IQR：3.71~16.79）d；其中7例为肺栓塞，4例为深静脉血栓形成。16例（5.90%）术后发生颅内出血，中位时间为术后18.50（IQR：4~64）h，其中13例发生在术后24 h内，3例在服用抗凝剂后CT扫描发现出血。多因素logistic回归分析显示抗凝治疗启动时间延迟脑膜瘤术发生血栓栓塞、颅内出血的独立危险因素（P<0.05）。11例血栓栓塞中，8例（72.73%）mRS评分3~6分，16例颅内出血中，7例（43.75%）mRS评分3~6分。4例死亡，其中2例死于肺栓塞，1例颅内出血并脓毒性休克病人放弃治疗后死亡，1例颅内出血死于不明原因的脑梗死。结论 脑膜瘤术后延迟抗凝治疗会增加颅内出血、血栓栓塞的风险。而血栓栓塞对预后的影响大于颅内出血，因此建议脑膜瘤术后早期启动预防性抗凝治疗。
Abstract:
Objective To investigate the relationship between postoperative anticoagulant therapy (AC) and postoperative intracranial hemorrhage (ICH) and thromboembolic events (TE) in patients with meningionmas. Methods The clinical data of 271 patients with meningiomas underwent microsurgery from January 2016 to December 2022 were retrospectively analyzed. The primary end points were postoperative ICH and TE (including mesenteric embolism, pulmonary embolism, deep vein thrombosis, cerebral infarction, myocardial infarction). The secondary endpoint was death at 30 days after surgery, and the clinical outcome was assessed using the modified Rankin Scale (mRS) score. Results Eleven patients (4.05%; 7 pulmonary embolism and 4 deep vein thrombosis) suffered from TE, and the median time of occurrence was 11.17 (IQR: 3.71~16.79) days. ICH occurred in 16 patients (5.90%); the median time was 18.50 (IQR: 4~64) h after surgery; 13 patients occurred within 24 h after surgery and 3 were found bleeding by CT scan after AC therapy. Multivariate logistic regression analysis showed that delayed AC therapy was an independent risk factor for ICH and TE (P<0.05). Of 11 patients with TE, 8 patients (72.73%) had a mRS score of 3~6. Of 16 patients with ICH, 7 patients (43.75%) had a mRS score of 3~6. Four patients died, of whom 2 died of pulmonary embolism, 1 died of ICH and septic shock after abandoning treatment, and 1 died of cerebral infarction of unknown cause. Conclusions Delayed AC therapy may increase the risk of ICH and TE in patients with meningiomas after operation. TE has a greater impact than ICH on prognosis of patients with meningiomas, so it is recommended to start preventive AC therapy early after surgery.

参考文献/References:

[1]BURTH S, OHMANN M, KRONSTEINER D, et al. Prophylactic anticoagulation in patients with glioblastoma or brain metastases and atrial fibrillation: an increased risk for intracranial hemorrhage [J]. Neurooncol, 2021,152(3): 483-490.
[2]HANTSCHE A, WILHELMY F, KASPER J, et al. Earlyprophylactic anticoagulation after subarachnoid hemorrhage decreases systemic ischemia and improves outcome [J]. Clin Neurol Neurosurg, 2021, 207(1): 106809-106815.
[3]KOJI T, KUBO Y, MATSUMOTO Y, et al. Intracranial hemorrhage associated with direct oral anticoagulant after clipping for an unruptured cerebral aneurysm: a report of two cases [J]. Surg Neurol Int, 2022, 13(1): 104-108.
[4]SHAH S, URTECHO M, FIRWANA M, et al. Perioperative management of antiplatelet therapy: a systematic review and meta-analysis [J]. Mayo Clin Proc Innov Qual Outcomes, 2022, 6(6): 564-573.
[5]SAITO K, SAITO Y, MURAMATSU T, et al. Impact of perioperative antithrombotic strategies on clinicalevents in non-cardiac surgery [J]. Heart Vessels, 2022, 37(8): 13371343.
[6]DOUKETIS JD, SPYROPOULOS AC, MURAD MH, et al. Perioperative management of antithrombotic therapy: an American College of Chest Physicians clinical practice guideline [J]. Chest, 2022, 162(5): e207-e243.
[7]符伟国,王利新. 围手术期静脉疾病诊治争议与共识[J]. 中国实用外科杂志，2015，（1）：66-68,71.
[8]BELL JS, FLORENCE TJ, PHILLIPS HW, et al. Comparisonof the safety of prophylactic anticoagulants after intracranialsurgery [J]. Neurosurgery, 2021, 89(3): 527-536.
[9]JM IA, CARPENTER EK, HAEHN DA, et al. Perioperative resumption of direct oral anticoagulants: review of the Mayoclinic experience [J]. South Med J, 2021, 114(7): 442-444.
[10]DE MELO JUNIOR JO, MELO MALC, JUNIOR LASL, et al. Therapeutic anticoagulation for venous thromboembolismafter recent brain surgery: evaluating the risk of intracranial hemorrhage [J]. Clin Neurol Neurosurg, 2020, 197(1): 106202-106208.
[11]WANG X, ZHOU YC, ZHU WD, et al. The risk of postoperative hemorrhage and efficacy of heparin for preventing deep vein thrombosis and pulmonary embolism in adult patients undergoing neurosurgery: a systematic review and meta-analysis [J]. J Investig Med, 2017, 65(8): 1136-1146.
[12]GEORGAKOPOULOU VE, MATHIOUDAKIS N,PAPALEXIS P, et al. Factors related to morbidity and mortality of meningiomas resection associated venous thromboembolism (Review) [J]. Mol Clin Oncol, 2023, 19(3): 70-79.
[13]RIZZO SM, TAVAKOL S, BI WL, et al. Meningioma resection and venous thromboembolism incidence, management, and outcomes [J]. Res Pract Thromb Haemost, 2023, 7(2): 100121.

相似文献/References:

[1]林国中　王振宇　马长城　赵　薇.神经电生理监测下显微手术切除脊髓髓内肿瘤[J].中国临床神经外科杂志,2015,(11):647.[doi:10.13798/j.issn.1009-153X.2015.11.003]
　LIN Guo-zhong,WANG Zhen-yu,MA Chang-cheng,et al.Clinical value of intraoperative electrophysiological monitoring to microsurgery for intramedullary spinal tumors[J].,2015,(10):647.[doi:10.13798/j.issn.1009-153X.2015.11.003]
[2]谢京城　王振宇　陈晓东.骶管终丝脊膜囊肿合并脊髓拴系综合征的诊断和治疗[J].中国临床神经外科杂志,2015,(11):651.[doi:10.13798/j.issn.1009-153X.2015.11.004]
　XIE Jing-cheng,WANG Zhen-yu,CHEN Xiao-dong.Diagnosis and surgical treatment of sacral spinal meningeal cysts of fila terminale complicated with tethered spinal cord syndrome[J].,2015,(10):651.[doi:10.13798/j.issn.1009-153X.2015.11.004]
[3]于　涛　黄正通　王振宇.椎管内脊膜囊肿的临床特征和治疗方法[J].中国临床神经外科杂志,2015,(11):654.[doi:10.13798/j.issn.1009-153X.2015.11.005]
　YU Tao,HUANG Zheng-tong,WANG Zhen-yu.Clinical features and treatment of intraspinal arachnoid cysts[J].,2015,(10):654.[doi:10.13798/j.issn.1009-153X.2015.11.005]
[4]谢宝树　王　宇　贾　锋　张　林　殷玉华.神经电生理监测下显微手术治疗成人脊髓栓系综合征[J].中国临床神经外科杂志,2015,(11):658.[doi:10.13798/j.issn.1009-153X.2015.11.006]
　XIE Bao-shu,WANG Yu,JIA Feng,et al.Intraoperative electrophysiological monitoring-guided microsurgery on tethered spinal cord syndrome in adults[J].,2015,(10):658.[doi:10.13798/j.issn.1009-153X.2015.11.006]
[5]赵东升　王正君　孙刚锋　费　舟　姬西团　李　娟　万晓强.椎管内畸胎瘤的诊断与治疗[J].中国临床神经外科杂志,2015,(11):661.[doi:10.13798/j.issn.1009-153X.2015.11.007]
　ZHAO Dong-sheng,WANG Zheng-jun,SUN Gang-feng,et al.Dignosis and treatment of intraspainal teratomas[J].,2015,(10):661.[doi:10.13798/j.issn.1009-153X.2015.11.007]
[6]陈晓东　于　涛　王振宇.脊髓髓内神经鞘瘤的诊断与治疗[J].中国临床神经外科杂志,2015,(11):670.[doi:10.13798/j.issn.1009-153X.2015.11.010]
　CHEN Xiao-dong,YU Tao,WANG Zhen-yu.Diagnosis and treatment of intramedullary spinal schwannomas[J].,2015,(10):670.[doi:10.13798/j.issn.1009-153X.2015.11.010]
[7]马　磊　张海红　张　威　衡立君　孙树凯　贾　栋.眶上锁孔入路手术切除前颅底脑膜瘤的临床效果[J].中国临床神经外科杂志,2015,(11):680.[doi:10.13798/j.issn.1009-153X.2015.11.013]
　MA Lei,ZHANG Hai-hong,ZHANG Wei,et al.Microsurgery through supraorbital keyhole approach for anterior cranial fossa meningiomas[J].,2015,(10):680.[doi:10.13798/j.issn.1009-153X.2015.11.013]
[8]张兆斯　但　炜　王　刚　周　超　孙　超　谢延风　石全红　詹　彦.咪达唑仑和丙泊酚诱导麻醉对继发性癫痫术中皮层脑电图的影响[J].中国临床神经外科杂志,2016,(05):261.[doi:10.13798/j.issn.1009-153X.2016.05.002]
　ZHANG Zhao-si,DAN Wei,WANG Gang,et al.Effects of midazolam or propofol used for induction of anesthesia on intraoperative ECoG in patients with secondary epilepsy[J].,2016,(10):261.[doi:10.13798/j.issn.1009-153X.2016.05.002]
[9]赵　平　王雄伟　汪　雷　马金阳.显微手术和血管内栓塞术治疗颅内动脉瘤的疗效分析[J].中国临床神经外科杂志,2016,(05):281.[doi:10.13798/j.issn.1009-153X.2016.05.008]
　ZHAO Ping,WANG Xiong-wei,WANG Lei,et al.Effect of endovascular treatment on intracranial aneurysms: a comparison with microsurgery[J].,2016,(10):281.[doi:10.13798/j.issn.1009-153X.2016.05.008]
[10]武　强　窦长武　张占普　富春雨　高乃康.中枢神经细胞瘤的影像特征及显微手术治疗 （附11例报告）[J].中国临床神经外科杂志,2016,(05):298.[doi:10.13798/j.issn.1009-153X.2016.05.014]
[11]李春坡　郑　军　李海元　边　涛　韩安国.侧脑室三角区小型脑膜瘤的显微外科治疗[J].中国临床神经外科杂志,2015,(11):694.[doi:10.13798/j.issn.1009-153X.2015.11.018]
[12]王林风　郑华山　操　廉.中央沟区矢状窦旁脑膜瘤的显微手术治疗（附25例报告）[J].中国临床神经外科杂志,2016,(07):431.[doi:10.13798/j.issn.1009-153X.2016.07.014]
[13]王　一　崔焕喜　林令超　孙思辉　李绍山　周庆九　刘　波　柳　琛.侧脑室三角区脑膜瘤的显微手术治疗[J].中国临床神经外科杂志,2016,(03):161.[doi:10.13798/j.issn.1009-153X.2016.03.010]
　WANG Yi,CUI Huan-xi,LIN Ling-chao,et al.Microsurgery for meningiomas in the trigones of lateral ventricles (report of 47 cases)[J].,2016,(10):161.[doi:10.13798/j.issn.1009-153X.2016.03.010]
[14]肖宗宇　陈晓娟　裴　杰　贺瑛福　许常林　马进海.超声吸引器在脑膜瘤手术切除中的应用[J].中国临床神经外科杂志,2015,(10):626.[doi:10.13798/j.issn.1009-153X.2015.10.016]
[15]杨　俊　吴雪松　莫鸿忠　潘荣南　赖　杰.双源CT三维血管成像技术在脑膜瘤术前评估中的应用[J].中国临床神经外科杂志,2015,(06):347.[doi:10.13798/j.issn.1009-153X.2015.06.009]
　YANG Jun,WU Xue-song,MO Hong-zhong,et al.Application of three-dimensional dual-source CT angiography to preoperative assessment of meningiomas[J].,2015,(10):347.[doi:10.13798/j.issn.1009-153X.2015.06.009]
[16]张祎年　黄文彪　潘亚文.鞍区脑膜瘤的显微手术治疗及预后影响因素分析[J].中国临床神经外科杂志,2015,(01):11.[doi:10.13798/j.issn.1009-153X.2015.01.004]
　ZHANG Yi-nian,HUANG Wen-biao,PAN Ya-wen..Microsurgery for sellar meningiomas and analysis of factors related to the prognoses[J].,2015,(10):11.[doi:10.13798/j.issn.1009-153X.2015.01.004]
[17]王　雷　简志宏　易　伟　王　峻　连海伟　余信远　丁　昊　刘仁忠.经顶枕入路手术切除侧脑室三角区脑膜瘤[J].中国临床神经外科杂志,2016,(10):615.[doi:10.13798/j.issn.1009-153X.2016.10.016]
[18]刘　羽,谢　涛,毛　峰,等.角回后方皮层入路显微手术切除侧脑室三角区脑膜瘤[J].中国临床神经外科杂志,2016,(11):667.[doi:10.13798/j.issn.1009-153X.2016.11.005]
　LIU Yu,XIE Tao,MAO Feng,et al.Microsurgery through transcortical approach behind the angular gyrus for lateral ventricle trigone meningiomas[J].,2016,(10):667.[doi:10.13798/j.issn.1009-153X.2016.11.005]
[19]吴有志,罗良生,张　健,等.窦镰旁脑膜瘤的显微手术治疗[J].中国临床神经外科杂志,2016,(12):783.[doi:10.13798/j.issn.1009-153X.2016.12.019]
[20]段勇刚　谭占国　袁　波.鞍区脑膜瘤不同手术入路疗效的对比分析[J].中国临床神经外科杂志,2017,(04):239.[doi:10.13798/j.issn.1009-153X.2017.04.011]
　DUAN Yong-gang,TAN Zhan-guo,YUAN Bo..Curative effects of neurosurgery on suprasellar and parasellar meningiomas: supraobital lateral approach versus pterional approach[J].,2017,(10):239.[doi:10.13798/j.issn.1009-153X.2017.04.011]

备注/Memo

备注/Memo:
（2023-08-04收稿，2023-09-15修回）
更新日期/Last Update: 2023-10-31