张利军,惠鑫,田大臣,陈旺,王贤军

• 1:青岛大学第十一附属医院神经内科
• 2:泰山医学院
• 3:临沂市人民医院神经内科

摘要(Abstract)：

目的:探讨血管内治疗急性动脉粥样硬化性颅内前循环大血管闭塞患者早期应用抗血小板药物的安全性。方法:回顾性纳入因动脉粥样硬化性颅内前循环大血管闭塞引起的急性缺血性卒中(AIS)予以重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓桥接血管内治疗的患者56例。所有患者均于术中启用标准剂量替罗非班,负荷剂量10μg/kg静脉推注3 min,后以0.15μg/(kg·min)持续泵至术后24 h。术后复查头颅CT排除出血后给予口服阿司匹林100 mg联合氯吡格雷75 mg抗血小板聚集治疗。采用改良脑梗死溶栓分级(mTICI)评估血管再通情况;参照ECASSⅡ标准评估颅内出血转化,观察3 d内颅内出血(ICH)、症状性颅内出血(s ICH)、其他系统出血发生率;观察患者术后3 d内、3月后死亡率;依据3月后患者改良Rankin评分(mRS)评估日常独立生活能力。结果:56例急性前循环动脉粥样硬化性大血管闭塞患者中,术中实现血管成功再通51例;3 d内发生ICH10例,其中sICH 4例,无其他系统出血;出现血小板减少2例,无颅内出血转化;术后3 d内死亡2例,分别死于严重脑疝、重症肺炎。所有出院患者3月后均得到随访,mRS≤2分29例;术后3月死亡7例。结论:对急性颅内前循环动脉粥样硬化性大血管闭塞接受静脉溶栓桥接血管内治疗的患者,术中联用替罗非班治疗安全。

关键词(KeyWords)： 急性缺血性卒中;动脉粥样硬化;替罗非班;安全性

Abstract:

Keywords:

基金项目(Foundation): 山东省临沂市科技发展计划项目（No.201717005）

作者(Author): 张利军,惠鑫,田大臣,陈旺,王贤军

DOI: 10.16780/j.cnki.sjssgncj.20190163

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