摘要
目的探讨血栓弹力图(TEG)在小型颅内动脉瘤(IAs)术后病人中的应用价值。方法收集2017-03—2020-01在南阳市中心医院脑血管介入科行颅内动脉瘤支架辅助栓塞术的126例动脉瘤患者的临床资料。术前2 h给予阿司匹林联合氯吡格雷300 mg,术后行血栓弹力图检查,通过TEG相关结果评价患者术中情况,分别以AA、AP抑制率以及血栓形成的最大振幅表示,并于6个月后随访,观察患者术后并发症及mRS评分。结果术后24 h内AA抑制率(53.90±33.30)%,ADP抑制率(69.30±25.00)%,均显著高于术前(P<0.05);血栓形成的最大振幅值(50.80±34.60)mm,显著低于术前。术后随访,与术前、术后24 h时相比,术后6个月AA抑制率(70.00±25.20)%及ADP抑制率(80.00±26.20)%显著升高(F=5.983,P=0.023;F=6.621,P=0.028);血栓形成的最大振幅值(50.80±34.60)mm显著降低(F=7.100,P=0.013)。术后患者使用的支架数量、术后栓塞程度比较差异均无统计学意义(P>0.05)。围手术期及随访期间血栓相关并发症5例,随访期间发生短暂性缺血2例,支架内狭窄或闭塞2例,脑梗死2例。术后随访mRS评分0~2分118例,3~6分8例,术后预后良好率达93.33%。血栓形成的最大振幅(OR=1.214,95%CI:1.001~1.312)与术后并发症的发生密切相关。结论TEG检查对颅内小动脉瘤患者术后抗凝药物疗效的监测及术后并发症的预测有较大价值。
Objective To investigate the role of thromboelastography in the postoperative management of small cerebral aneurysm patients.Methods The clinical data of 126 patients with aneurysms who underwent cere⁃bral aneurysm stent-assisted embolization from March 2017 to January 2020 were collected.All patients were given a loading dose of aspirin combined with Clopidogrel 300mg nasal feeding 2 hours before operation.After operation,the patients were examined by thrombelastography.AA,AP inhibition rate and maximum amplitude of thrombus for⁃mation were measured.The postoperative complications and mRS scores were observed after 6 months.Results The rate of AA inhibition(53.90±33.30)%and the rate of ADP inhibition(69.30±25.00)%were significantly higher than those before operation.The maximum amplitude of thrombus formation was(50.80±34.60)mm,significantly lower than that before operation(P>0.05).The rate of AA inhibition(70.00±25.20)%and ADP inhibition(80.00±26.20)%were significantly higher than those before and 24 hours after surgery(F=5.983,P=0.023;F=6.621,P=0.028).The maximum amplitude of thrombosis was(50.80±34.60)mm(F=7.100,P=0.013).There was no signifi⁃cant difference in the number of stents used and the degree of Embolization(P>0.05).There were 5 cases of throm⁃bus-related complications,2 cases of transient ischemia,2 cases of in-stent stenosis or occlusion,and 2 cases of cerebral infarction.During postoperative follow-up,mRS scores ranged from 0 to 2 in 118 cases and from 3 to 6 in 8 cases,with a good prognosis rate of 93.33%.Conclusion TEG examination can clinically monitor the efficacy of anticoagulant drugs in patients with intracranial aneurysms and predict postoperative complications of patients.It is worthy of clinical promotion.
作者
茹睿
崔萍
宗余余
王玉
刘义锋
韩燕梅
柏慧
张缦莉
温昌明
RU Rui;CUI Ping;ZONG Yuyu;WANG Yu;LIU Yifeng;HAN Yanmei;BAI Hui;ZHANG Manli;WEN Changming(Nanyang Central Hospital,Nanyang 473000,China)
出处
《中国实用神经疾病杂志》
2021年第20期1802-1809,共8页
Chinese Journal of Practical Nervous Diseases
基金
河南省科技发展计划项目(编号:192102310349)。
关键词
小型颅内动脉瘤
血栓弹力图
抗凝治疗
血栓
ADP抑制率
AA抑制率
Small cerebral aneurysm
Thrombelastogram
Anticoagulant therapy
Thrombus
ADP inhibi⁃tion rate
AA inhibition rate
