国产氢氯吡格雷（泰嘉）在脑血管支架成形术（CAS）围手术期应用的疗效和安全性临床观察

发布时间：2018-06-23 22:38

本文选题：氢氯吡格雷 + 脑血管支架成形术　；参考：《苏州大学》2014年硕士论文

【摘要】：目的：观察国产氢氯吡格雷（泰嘉）在脑血管支架成形术（CAS）围手术期应用的疗效和安全性。方法：入选脑供血动脉狭窄拟行脑血管支架成形术的患者共20例，所有入选患者CAS术前日剂量为75mg泰嘉，，至少于CAS7天以前开始服用。术后服用泰嘉75mg3个月，每日1次口服。所有入选患者研究期间均同时合用拜阿斯匹灵肠溶片200mg/晚。研究主要终点为随访三个月的主要脑血管事件（包括卒中、血管性死亡、靶血管紧急血运重建、出血）；次要终点为心肌梗死、外周血管的缺血事件、中性粒细胞降低、肝功能受损（转氨酶升高）。结果：在入组的20例患者中，前循环梗死10例，后循环梗死8例，后循环TIA2例(左锁骨下盗血引起)，重度狭窄(＞70%)22处，中度狭窄(50-70%)2处，均为责任病灶;共置入支架24枚，其中颈动脉支架10枚，椎动脉开口支架10枚，椎动脉颅内段支架1枚(Winspan)，锁骨下动脉支架3枚；手术成功率100%，围手术期1例出现较明显窦反应（研究编号为012号），该患者R-ICA85%狭窄，窦反应持续10余天，术后第7天出现前循环TIA,，急升压扩容后恢复。入组时和用药三月后比较，空腹血糖、LDL-c、CRP、Fg均有所下降，差异具有统计学意义（P＜0.05），白细胞、血肌酐有所升高，血小板稍有降低，差异无统计学意义，血ALT、AST稍有升高，差异无统计学意义，除两例出现轻度异常外，其他均在正常范围。入组时平均NIHSS(8.64±2.22)，3月随访时(4.54±2.78)，差异具有统计学意义（P值：0.004）；3月随访时mRS(1.60±0.78)，mRS≤2分(16/20：80%)，大部分患者神经功能恢复良好。围手术期观察主要脑血管事件仅发生TIA一例，血管性死亡、靶血管紧急血运重建、出血事件均为0。次要终点事件仅发生肝功能轻度受损（转氨酶轻度升高）：2/20(10%)，心肌梗死、外周血管的缺血事件、中性粒细胞降低均为0。不良反应出现肝功能（ALT、AST）受损：2例(轻度升高，都伴有CK升高)，1例他汀减量、1例停用他汀后恢复正常，皮肤及附属组织疾病：1例瘙痒(未停药,对症处理后好转)，其他不良反应包括：胃肠道疾病、血小板性出血和凝血疾病、中枢及周围神经系统疾病均为0。结论：泰嘉用于脑动脉支架置入术围手术期疗效可靠，安全性良好，可以作为CAS围手术期与阿司匹林联合抗血小板治疗的药物。
[Abstract]:Objective: to observe the efficacy and safety of domestic hydroclopidogrel (TEC) in perioperative cerebral vascular stent angioplasty (CAS). Methods: a total of 20 patients with cerebral artery stenosis were enrolled in this study. The daily dose of 75mg before CAS was taken at least 7 days before CAS. Take Taijia 75mg3 once a day for months after operation. All patients were enrolled in the study at the same time combined with Baispiling enteric-coated tablets 200mg/ late. The main endpoints of the study were major cerebrovascular events (including stroke, vascular death, target vessel emergency revascularization, hemorrhage), and secondary endpoints were myocardial infarction, ischemic events of peripheral blood vessels, and decreased neutrophils. Impaired liver function (elevated aminotransferase). Results: of the 20 patients, 10 were anterior circulation infarction, 8 posterior circulation infarction, 2 posterior circulation TIA (left subclavian steal), 22 severe stenosis (> 70%) and 2 moderate stenosis (50-70%). There were 10 stents in carotid artery, 10 stents in open vertebral artery, 1 stenting in intracranial segment of vertebral artery (Winspan) and 3 stents in subclavian artery. The sinus reaction lasted for more than 10 days, and the anterior circulation TIAA was found on the 7th day after operation. Compared with the three months after treatment, the fasting blood glucose level of LDL-cU CRPPfg was significantly decreased (P < 0.05), the white blood cells and serum creatinine were increased, the platelet was slightly decreased, the difference was not statistically significant, and the level of alt was slightly higher than that of the control group (P < 0.05). The difference was not statistically significant, except for two cases with mild abnormality, the rest were within normal range. The average NIHSS was (8.64 卤2.22) at admission and 4.54 卤2.78 at 3 months follow-up (P: 0.004), and Mrs was (1.60 卤0.78) / (16 / 20: 80%) at 3-month follow-up. Only one case of TIA was observed in perioperative period. Vascular death and emergency revascularization of target vessels were observed. Minor endpoint events occurred only slightly impaired liver function (slightly elevated aminotransferase): 2 / 20 (10%), myocardial infarction, peripheral blood vessel ischemia events, neutrophilic decreased to 0. 5%. Adverse reactions occurred in 2 cases with impaired liver function (mild elevation, accompanied by CK elevation), 1 case with statins, 1 case returned to normal after withdrawal of statins, 1 case with skin and subsidiary tissue diseases, 1 case with pruritus. Other adverse reactions included gastrointestinal diseases, platelet bleeding and coagulation, and central and peripheral nervous system diseases. Conclusion: Tegar is effective and safe in the perioperative period of cerebral artery stenting. It can be used as antiplatelet therapy combined with aspirin and CAS perioperative period.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743

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