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目的探讨替罗非班在颅内破裂动脉瘤介入栓塞治疗术中应用的安全性和有效性。方法回顾性分析2012年1月至2014年11月因颅内动脉瘤破裂在河南省人民医院接受介入栓塞治疗且术中应用替罗非班患者的临床资料。替罗非班应用方案:支架释放前或单纯弹簧圈栓塞完成时经静脉给予负荷剂量(8.0μg/kg,3 min内推注完毕),继而维持剂量(0.1μg·kg-1·min-1)至术后24 h,撤药前2 h给予负荷剂量抗血小板口服药物替换。观察分析替罗非班相关颅内出血和血栓栓塞事件。结果入组208例患者中支架辅助栓塞166例(79.81%),单纯弹簧圈栓塞42例(20.19%)。替罗非班相关颅内出血4例(1.92%,均发生在支架辅助栓塞队列),其中术中3例(1.44%),术后1例(0.48%);血栓栓塞事件6例(2.88%,支架辅助栓塞5例,单纯弹簧圈栓塞1例),其中术中支架内血栓形成1例(0.48%),术后维持用药期间血栓栓塞相关症状5例(2.40%)。结论经静脉负荷剂量继而维持剂量替罗非班在颅内破裂动脉瘤介入栓塞治疗术中预防性应用是安全、有效的。
Objective To investigate the safety and efficacy of tirofiban in interventional embolization of intracranial ruptured aneurysms. Methods The clinical data of patients with tirofiban who were treated by embolization in Henan Provincial People’s Hospital from January 2012 to November 2014 for the rupture of intracranial aneurysms were retrospectively analyzed. Tirofiban Application: The stent was infused with a loading dose (8.0 μg / kg bolus within 3 min) before the stent was released or when the coil was simply embolized, followed by maintenance of the dose (0.1 μg · kg -1 · min -1 ) To 24 h after surgery, 2 h before withdrawal to give the loading dose of antiplatelet oral drug replacement. Observation and analysis of tirofiban-related intracranial hemorrhage and thromboembolism. Results Among the 208 patients, 166 cases (79.81%) had stent-assisted embolization, and 42 cases (20.19%) had coil embolization alone. Tirofiban-related intracranial hemorrhage occurred in 4 patients (1.92%, both in stent-assisted embolization cohort), of which 3 were intraoperative (1.44%), 1 postoperative (0.48%); 6 were thromboembolic events (2.88% Stent-assisted embolization in 5 cases, simple coil embolization in 1 case), including intra-stent thrombosis in 1 case (0.48%) and postoperative maintenance of thromboembolism-related symptoms in 5 cases (2.40%). Conclusions It is safe and effective to use propofol at a dose equivalent to intravenous infusion of tirofiban in the interventional treatment of intracranial rupture aneurysms.