【摘要】 目的 探讨替罗非班联合双抗血小板治疗在颅内动脉瘤支架辅助栓塞术后抗血栓中的应用价值。方法前瞻性选取2020年1月至2024年1月喀什地区第一人民医院收治的100例颅内动脉瘤患者，依据随机数字表法将患者分为试验组与对照组，每组各50例。所有患者均采取支架辅助栓塞术治疗，对照组术后采取双抗血小板进行抗血栓治疗，试验组在对照组基础上增加替罗非班治疗。比较两组治疗前及治疗后3个月血栓弹力图参数[最大振幅（MA值）、反应时间（R值）、凝固时间（K值）]及治疗后3个月的支架内血栓发生率;治疗前及治疗后3个月的凝血功能[凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、纤维蛋白原（FIB）、织因子途径抑制物（TFPI）]、血管内皮功能[内皮素-1、一氧化氮、血管内皮生长因子（VEGF）]、脑血流动力学[大脑中动脉平均血流速度、脑氧代谢率、局部脑氧饱和度（r SO₂）]，并比较两组出血事件发生率。结果 治疗后3个月，两组MA值、R值、K值均较治疗前降低，且试验组MA值、R值、K值均低于对照组，差异均有统计学意义（P<0.05）。试验组血栓发生率低于对照组，差异有统计学意义（P<0.05）。治疗后3个月，两组PT、APTT、TFPI活性均较治疗前升高，FIB均较治疗前降低，且试验组PT、APTT、TFPI活性均高于对照组，试验组FIB低于对照组，差异均有统计学意义（P<0.05）。治疗后3个月，两组内皮素-1水平均较治疗前降低，一氧化氮、VEGF水平均较治疗前升高，且试验组内皮素-1低于对照组，试验组一氧化氮、VEGF水平均高于对照组，差异均有统计学意义（P<0.05）。治疗后3个月，两组脑血流速度、脑氧代谢率、r SO₂均较治疗前升高，且试验组脑血流速度、脑氧代谢率、r SO₂均高于对照组，差异均有统计学意义（P<0.05）。两组出血事件总发生率差异无统计学意义（P > 0.05）。结论 替罗非班联合双抗血小板治疗在颅内动脉瘤支架辅助栓塞术后抗血栓治疗效果显著，可改善患者血栓弹力图，降低远期血栓发生率，且能够改善患者凝血功能，提升血管内皮功能，改善脑血流动力学，安全性较高。更多还原

【Abstract】 Objective To explore the application value of tirofiban combined with dual antiplatelet therapy in the anti thrombotic treatment of intracranial aneurysms after stent assisted embolization. Methods One hundred patients with intracranial aneurysms admitted to the First People’s Hospital of Kashgar from January 2020 to January 2024 were prospectively selected. According to the random number table method,the patients were divided into the experimental group and the control group,with 50 cases in each group. All patients underwent stent-assisted embolization. The control group received dual antiplatelet therapy for antithrombosis after surgery,while the experimental group received additional tirofiban treatment on the basis of the control group. The thrombelastogram parameters [maximum amplitude（ MA value）,reaction time（ R value）,coagulation time（ K value） ] before treatment and 3 months after treatment and the incidence of stent thrombosis 3 months after treatment were compared between the two groups. The coagulation function [prothrombin time（ PT）,activated partial thromboplastin time（ APTT）,fibrinogen（ FIB）,tissue factor pathway inhibitor（ TFPI） ],vascular endothelial function [endothelin-1,nitric oxide,vascular endothelial growth factor（ VEGF） ],cerebral hemodynamics [mean blood flow velocity of middle cerebral artery,cerebral oxygen metabolism rate,local cerebral oxygen saturation（ r SO₂） ]before treatment and 3 months after treatment were compared,and the incidence of bleeding events was compared between the two groups. Results At 3 months after treatment,the MA value,R value and K value of the two groups were lower than those before treatment,and the MA value,R value and K value of the experimental group were lower than those of the control group,the differences were statistically significant（ P < 0. 05）. The incidence of thrombosis in the experimental group was lower than that in the control group,the difference was statistically significant（ P < 0. 05）. At 3 months after treatment,the activities of PT,APTT and TFPI in the two groups were higher than those before treatment,FIB was lower than that before treatment,and the activities of PT,APTT and TFPI in the experimental group were higher than those in the control group,FIB in the experimental group was lower than that in the control group,the differences were statistically significant（ P < 0. 05）.At 3 months after treatment,the levels of endothelin-1 in the two groups were lower than those before treatment,and the levels of nitric oxide and VEGF were higher than those before treatment,and the levels of endothelin-1 in the experimental group were lower than those in the control group,and the levels of nitric oxide and VEGF in the experimental group were higher than those in the control group,the differences were statistically significant（ P < 0. 05）. At 3 months after treatment,the cerebral blood flow velocity,cerebral oxygen metabolism rate and r SO₂ in the two groups were higher than those before treatment,and the cerebral blood flow velocity,cerebral oxygen metabolism rate and r SO₂ in the experimental group were higher than those in the control group,the differences were statistically significant（ P < 0. 05）. There was no statistically significant difference in the overall incidence of bleeding events between the two groups（ P > 0. 05）. Conclusion The combination of tirofiban and dual antiplatelet therapy has a significant effect on antithrombotic therapy after stent assisted embolization of intracranial aneurysms. It can improve the thromboelastography of patients,reduce the incidence of long-term thrombosis,and improve coagulation function,endothelial function,cerebral hemodynamics,with high safety.更多还原