微创医学

目的探讨抗凝抗血小板序贯治疗在颅内动脉瘤破裂支架辅助栓塞术围手术期中的应用效果。方法选取50例接受支架辅助栓塞术治疗的颅内动脉瘤破裂患者作为研究对象，按照随机数字表法将患者分为观察组和对照组，每组25例。观察组采用抗凝抗血小板序贯治疗，对照组采用单纯双联抗血小板治疗。分别在术前、术后1 d、术后3 d，比较两组血小板计数（PLT）、凝血酶原时间（PT）、活化部分凝血活酶时间（APTT），纤维蛋白原（FIB）水平、D-二聚体（D-D）水平；术后6个月，比较两组预后情况及术后并发症发生情况。结果两组APTT、PT，FIB水平、D-D水平比较，差异有统计学意义（P<0.05）；两组PLT、APTT、PT，FIB水平、D-D水平有随时间变化的趋势（P<0.05）；PT、APTT，FIB水平、D-D水平分组与时间存在交互效应（P<0.05）。进一步行分组因素的简单效应分析，术后1 d和术后3 d，观察组PT、APTT，FIB水平、D-D水平高于对照组（P<0.05）；观察组预后良好率高于对照组，总并发症发生率低于对照组（P<0.05）。结论颅内动脉瘤破裂支架辅助栓塞术后采用抗凝抗血小板序贯治疗方案，可在维持凝血功能相对平衡的同时，降低严重血栓事件的发生风险，改善患者长期预后，且安全性与单纯双联抗血小板治疗相当，值得临床推广应用。

Objective To investigate the clinical outcomes of sequential anticoagulant and antiplatelet therapy during the perioperative period of stent-assisted embolization for ruptured intracranial aneurysms. Methods Fifty patients with ruptured intracranial aneurysms undergoing stent-assisted embolization were randomly divided into an observation group and a control group by the random number table method, with 25 cases in each group. The observation group received sequential anticoagulant and antiplatelet therapy and the control group received dual antiplatelet monotherapy. Platelet count (PLT), prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB) level and D-dimer (D-D) level were detected and compared preoperatively, on postoperative day 1 and postoperative day 3. Clinical prognosis and postoperative complications were assessed and compared at 6 months after surgery. Results There were statistically significant differences in APTT, PT, FIB level and D-D level between the two groups (P<0.05). PLT, APTT, PT, FIB level and D-D level all showed significant changing trends over time (P<0.05). Significant interaction effects between group and time were also detected for PT, APTT, FIB level and D-D level (P<0.05). Further simple effect analysis of the grouping factor demonstrated that at postoperative day 1 and postoperative day 3, the levels of PT, APTT, FIB level and D-D level in the observation group were higher than those in the control group (P<0.05). Moreover, the observation group had a higher rate of favorable prognosis and a lower overall incidence of postoperative complications relative to the control group (P<0.05). Conclusion Sequential anticoagulant and antiplatelet therapy following stent-assisted embolization for ruptured intracranial aneurysms preserves coagulation homeostasis, mitigates the risk of major thrombotic complications and optimizes long-term clinical outcomes. This therapeutic strategy presents a safety profile equivalent to dual antiplatelet monotherapy, which supports its broad clinical adoption.

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