双重抗血小板聚集治疗对动脉瘤性蛛网膜下腔出血的疗效评估

Efficacy evaluation of dual antiplatelet therapy in patients with aneurysmal subarachnoid hemorrhage

关键词:  迟发性脑缺血  蛛网膜下腔出血  抗血小板治疗  颅内动脉瘤

Key words:  delayed cerebral ischemia  subarachnoid hemorrhage  antiplatelet therapy  intracranial aneurysm

摘要:

目的探究双重抗血小板聚集（双抗）治疗对动脉瘤性蛛网膜下腔出血（aneurysmal subarachnoid hemorrhage， aSAH）患者迟发性脑缺血（delayed cerebral ischemia, DCI）的影响及疗效评估。方法回顾性地收集并分析了2019年1月—2021年12月在同济大学附属第十人民医院神经外科接受破裂动脉瘤介入栓塞治疗的186例aSAH患者的临床资料。根据有无使用双抗将患者分成双抗组和对照组，比较两组间DCI发生率、急性脑积水发生率、脑室外引流置管率、出血性并发症发生率、3个月功能预后的差异。结果186例aSAH患者中，有64例患者接受了支架辅助栓塞，接受了双抗治疗进而分为双抗组；有122例患者接受了单纯栓塞或球囊辅助栓塞，没有接受抗血小板聚集治疗，进而分为对照组。双抗组的DCI发生率低于对照组（14.1% vs 27.0%,P=0.044）。双抗组和对照组急性脑积水发生率（10.9% vs 10.7%, P=0.953）、脑室外引流置管率（4.7% vs 6.6%, P=0.608）、出血性并发症发生率（3.1% vs 0.8%, P=0.236）、3个月功能预后（mRS评分≤2分，90.6% vs 86.1%, P=0.370）差异无统计学意义。结论在接受了血管内治疗的aSAH患者中，使用双抗治疗能够降低DCI的发生率，且不会增加出血性并发症发生率，具有一定的临床应用前景。

Abstract:

ObjectiveTo evaluate the efficacy of dual antiplatelet therapy(DAPT) in patients with aneurysmal subarachnoid hemorrhage（aSAH）. MethodsClinical data of 186 aSAH patients who received endovascular treatment in Shanghai Tenth People’s Hospital between January 2019 and December 2021 were retrospectively analyzed. Patients were divided into two groups： patients who underwent stent-assisted coiling requiring DAPT(n=64, DAPT group) and patients who underwent coiling only or balloon-assisted coiling without DAPT(n=122, control group). The risk of delayed cerebral ischemia(DCI) , acute hydrocephalus, placement of an external ventricular drain(EVD), hemorrhagic complications, and 3-month functional outcome were compared between the two groups. ResultsThe risk of DCI in DAPT group was significantly lower than that in control group (14.1% vs 27.0%, P=0.044). There were no significant differences in acute hydrocephalus, EVD placement, hemorrhagic complications, and 3-month functional outcomes between the groups(all P>0.05). ConclusionThe use of DAPT is associated with a lower risk of DCI in aSAH patients following endovascular treatment.