本文選題：氫氯吡格雷 + 腦血管支架成形術(shù)�。� 參考：《蘇州大學(xué)》2014年碩士論文

【摘要】：目的：觀察國(guó)產(chǎn)氫氯吡格雷（泰嘉）在腦血管支架成形術(shù)（CAS）圍手術(shù)期應(yīng)用的療效和安全性。 方法：入選腦供血?jiǎng)用}狹窄擬行腦血管支架成形術(shù)的患者共20例，所有入選患者CAS術(shù)前日劑量為75mg泰嘉，，至少于CAS7天以前開始服用。術(shù)后服用泰嘉75mg3個(gè)月，每日1次口服。所有入選患者研究期間均同時(shí)合用拜阿斯匹靈腸溶片200mg/晚。研究主要終點(diǎn)為隨訪三個(gè)月的主要腦血管事件（包括卒中、血管性死亡、靶血管緊急血運(yùn)重建、出血）；次要終點(diǎn)為心肌梗死、外周血管的缺血事件、中性粒細(xì)胞降低、肝功能受損（轉(zhuǎn)氨酶升高）。 結(jié)果：在入組的20例患者中，前循環(huán)梗死10例，后循環(huán)梗死8例，后循環(huán)TIA2例(左鎖骨下盜血引起)，重度狹窄(＞70%)22處，中度狹窄(50-70%)2處，均為責(zé)任病灶;共置入支架24枚，其中頸動(dòng)脈支架10枚，椎動(dòng)脈開口支架10枚，椎動(dòng)脈顱內(nèi)段支架1枚(Winspan)，鎖骨下動(dòng)脈支架3枚；手術(shù)成功率100%，圍手術(shù)期1例出現(xiàn)較明顯竇反應(yīng)（研究編號(hào)為012號(hào)），該患者R-ICA85%狹窄，竇反應(yīng)持續(xù)10余天，術(shù)后第7天出現(xiàn)前循環(huán)TIA,，急升壓擴(kuò)容后恢復(fù)。入組時(shí)和用藥三月后比較，空腹血糖、LDL-c、CRP、Fg均有所下降，差異具有統(tǒng)計(jì)學(xué)意義（P＜0.05），白細(xì)胞、血肌酐有所升高，血小板稍有降低，差異無統(tǒng)計(jì)學(xué)意義，血ALT、AST稍有升高，差異無統(tǒng)計(jì)學(xué)意義，除兩例出現(xiàn)輕度異常外，其他均在正常范圍。入組時(shí)平均NIHSS(8.64±2.22)，3月隨訪時(shí)(4.54±2.78)，差異具有統(tǒng)計(jì)學(xué)意義（P值：0.004）；3月隨訪時(shí)mRS(1.60±0.78)，mRS≤2分(16/20：80%)，大部分患者神經(jīng)功能恢復(fù)良好。圍手術(shù)期觀察主要腦血管事件僅發(fā)生TIA一例，血管性死亡、靶血管緊急血運(yùn)重建、出血事件均為0。次要終點(diǎn)事件僅發(fā)生肝功能輕度受損（轉(zhuǎn)氨酶輕度升高）：2/20(10%)，心肌梗死、外周血管的缺血事件、中性粒細(xì)胞降低均為0。不良反應(yīng)出現(xiàn)肝功能（ALT、AST）受損：2例(輕度升高，都伴有CK升高)，1例他汀減量、1例停用他汀后恢復(fù)正常，皮膚及附屬組織疾�。�1例瘙癢(未停藥,對(duì)癥處理后好轉(zhuǎn))，其他不良反應(yīng)包括：胃腸道疾病、血小板性出血和凝血疾病、中樞及周圍神經(jīng)系統(tǒng)疾病均為0。 結(jié)論：泰嘉用于腦動(dòng)脈支架置入術(shù)圍手術(shù)期療效可靠，安全性良好，可以作為CAS圍手術(shù)期與阿司匹林聯(lián)合抗血小板治療的藥物。
[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 鹵2.22) at admission and 4.54 鹵2.78 at 3 months follow-up (P: 0.004), and Mrs was (1.60 鹵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.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R743

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