鹽酸沙格雷酯在腹主動脈瘤腔內修復術后防治臀肌和下肢缺血的初步觀察_《中國普外基礎與臨床雜志》

作者：

黃斌 ,  趙紀春 , 馬玉奎 , 盧武勝 , 楊軼 , 袁丁

四川大學華西醫院血管中心 (四川成都 610041);

關鍵詞：

腹主動脈瘤腔內修復術鹽酸沙格雷酯

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目的　觀察鹽酸沙格雷酯在腹主動脈瘤腔內修復術后防治臀肌和下肢缺血的作用。
方法　回顧性收集我院血管外科2006年1月至2011年1月期間收治的腹主動脈瘤行腔內修復術（EVAR）治療的患者174例，年齡（71.8±8.2）歲，其中男148例，女26例。腹主動脈瘤直徑（55.2±12.9） mm，累及髂總動脈52例（29.9%）。EVAR治療方法包括置入分叉型人工血管支架169例（97.1%），單臂型5例（2.9%）。其中術中封閉單側髂內動脈29例，封閉雙側髂內動脈10例，術后均口服鹽酸沙格雷酯100 mg，3次/d，阿司匹林100mg， 1次/d 2～4周。隨訪觀察術后患者臀肌和下肢發生缺血情況。
結果　全部病例行EVAR術順利，無中轉開腹；行全身麻醉88例（50.6%），硬膜外阻滯麻醉52例（29.9%），局部麻醉34例（19.5 %）；術中失血量為（125.2±43.1） ml，術中無輸血，手術時間為（145.5±38.7）min；術后ICU 觀察時間和禁食時間分別為（14.7±5.2） h 和（7.2±4.3）h；術后平均住院時間為（9.1±2.7） d。圍手術期并發癥發生率為12.6%（22/174），術后30 d死亡率為1.1%（2/174）。術中封閉單側髂內動脈29例中2例出現同側臀肌輕度疼痛，行走疼痛加重，跛行距離100m，5例出現同側下肢乏力，間歇性跛行距離100～200m；封閉雙側髂內動脈10例中4例術后出現臀肌輕度疼痛，跛行距離200m，均采用口服鹽酸沙格雷酯和阿司匹林擴血管、祛聚治療后2～4周好轉，間歇性跛行距離均大于500m，無臀肌壞死發生，無再行介入或外科干預治療，中位隨訪時間16.1個月，未訴特殊不適。
結論　鹽酸沙格雷酯在EVAR術后防治臀肌和下肢缺血療效滿意，尤其適合于封閉雙側或一側髂內動脈和合并下肢動脈硬化閉塞者。

引用本文： 黃斌,趙紀春,馬玉奎,盧武勝,楊軼,袁丁. 鹽酸沙格雷酯在腹主動脈瘤腔內修復術后防治臀肌和下肢缺血的初步觀察. 中國普外基礎與臨床雜志, 2012, 19(1): 82-86. doi: 復制

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6.	Libicher M， Pavlidis D， Bangard C， et al. Occlusion of the internal iliac artery prior EVAR： comparison of coils and plugs [J]. Vasc Endovascular Surg， 2011， Dec 14.[ Epub ahead of print].
7.	Bratby MJ， Munneke GM， Belli AM， et al. How safe is bilateral internal iliac artery embolization prior to EVAR [J]. Cardiovasc Intervent Radiol， 2008， 31(2)： 246-253.
8.	Hosaka A， Kato M， Kato I， et al. Outcome after concomitant unilateral embolization of the internal iliac artery and contralateral external-to-internal iliac artery bypass grafting during endovascular aneurysm repair [J]. J Vasc Surg， 2011， 54(4)： 960-964.
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11.	Maleux G， Koolen M， Heye S， et al. Limb occlusion after endovascular repair of abdominal aortic aneurysms with supported endografts [J]. J Vasc Interv Radiol，2008， 19(10)： 1409- 1412.
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13.	Houkin K， Nakayama N， Nonaka T， et al. The 5-hydroxytryptamine 2A receptor antagonist sarpogrelate hydrochloride inhibits acute platelet aggregation in injured endothelium [J]. J Int Med Res， 2006， 34(1)： 65-72.
14.	Shikata C， Nemoto M， Ebisawa T， et al. Effect of sarpogrelate on cardiovascular disorders [J]. Exp Clin Cardiol， 2011，16(3)： 75-76.
15.	Kajiwara I， Soejima H， Miyamoto S， et al. Effects of additional treatment of sarpogrelate to aspirin therapy on platelet aggregation and plasma plasminogen activator inhibitor activity in patients with stable effort angina [J]. Thromb Res， 2011，128(6)：547-551.
16.	Choi J， Kermode JC. New therapeutic approaches to combat arterial thrombosis： better drugs for old targets， novel targets， and future prospects[ J]. Mol Interv， 2011，11(2)： 111-123.
17.	Nakamura E， Tanaka N， Kuwabara M， et al. Relative contribu中國普外基礎與臨床雜志2012 年1 月第19 卷第1 期 Chin J Bases ? 86 ? Clin General Surg, Vol. 19, No. 1, Jan. 2012tions of 5-hydroxytryptamine (5-HT) receptor subtypes in 5-HTinduced vasoconstriction of the distended human saphenous vein as a coronary artery bypass graft [J]. Biol Pharm Bull， 2011，34(1)： 82-86.
18.	Horiuchi M， Okita K， Takada S， et al. Effects of oral singledose administration of sarpogrelate hydrochloride on saturation O2 of calf muscle during plantar flexion exercise [J]. Adv Exp Med Biol， 2010， 662： 531-536.
19.	Kim KM， Kim H， Chi HS， et al. Comparison of antiplatelet potency of sarpogrelate， aspirin， and beraprost in healthy volunteers according to in vitro closure time [J]. Blood Coagul Fibrinolysis， 2010，21(3)：262-265.
20.	Sun YM， Su Y， Jin HB， et al. Sarpogrelate protects against high glucose-induced endothelial dysfunction and oxidative stress [J]. Int J Cardiol，2011， 147(3)： 383-387.
21.	Hiroshi M，Hiroshi S. Effects of the 5-HT2A antagonist sarpogrelate on walking ability in patients with intermittent claudication as measured using the walking impairment questionnaire [J]. Ann Vasc Dis， 2008， 1 (2)：102-110.
22.	Kodama A， Komori K， Kajikuri J， et al. Chronic treatment of hydroxytryptamine type 2a receptor antagonist sarpogrelate hydrochloride modulates the vasoreactivity of serotonin in experimental rabbit vein grafts [J]. J Vasc Surg， 2009， 50(3)： 617-625.[ 23] Kodama A， Komori K， Hattori K， et al. Sarpogrelate hydrochloride reduced intimal hyperplasia in experimental rabbit vein graft [J]. J Vasc Surg， 2009，49(5)： 1272-1281.
23.	Nishihira K， Yamashita A， Tanaka N， et al. Serotonin induces vasoconstriction of smooth muscle cell-rich neointima through 5-hydroxytryptamine 2A receptor in rabbit femoral arteries [J].J Thromb Haemost， 2008， 6(7)： 1207-1214.
24.	Bir SC， Fujita M， Marui A， et al. New therapeutic approach for impaired arteriogenesis in diabetic mouse hindlimb ischemia[J]. Circ J， 2008， 72(4)： 633-640.[ 26] Shimizu T，Yamada Y，Tashita A，et al. Pharmacokinetic analysis of antiplatelet effect of sarpogrelate hydrochloride and its application to drug dosage regimen－ modeling based on reversible inhibition of 5-HT2 serotonergic receptor in the platelet membrane by sarpogrelate hydrochloride and its metabolite [J].Yakugaku Zasshi， 1999，19(11)：850-860.

1. Baril DT， Kahn RA， Ellozy SH， et al. Endovascular abdominal aortic aneurysm repair： emerging developments and anesthetic considerations [J]. J Cardiothorac Vasc Anesth， 2007， 21(5)：730-742.
2. Heller JA， Weinberg A， Arons R， et al. Two decades of abdominal aortic aneurysm repair： have we made any progress [J]. J Vasc Surg， 2000， 32(6)： 1091-1100.
3. Parodi JC， Palmaz JC， Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms [J]. Ann Vasc Surg，1991， 5(6)： 491-499.
4. Cochennec F， Marzelle J， Allaire E， et al. Open vs. endovascular repair of abdominal aortic aneurysm involving the iliac bifurcation [J]. J Vasc Surg，2010，51(6)： 1360-1366.
5. Zander T， Baldi S， Rabellino M， et al. Bilateral hypogastric artery occlusion in endovascular repair of abdominal aortic aneurysms and its clinical significance [J]. J Vasc Interv Radiol，2007， 18(12)： 1481-1486.
6. Libicher M， Pavlidis D， Bangard C， et al. Occlusion of the internal iliac artery prior EVAR： comparison of coils and plugs [J]. Vasc Endovascular Surg， 2011， Dec 14.[ Epub ahead of print].
7. Bratby MJ， Munneke GM， Belli AM， et al. How safe is bilateral internal iliac artery embolization prior to EVAR [J]. Cardiovasc Intervent Radiol， 2008， 31(2)： 246-253.
8. Hosaka A， Kato M， Kato I， et al. Outcome after concomitant unilateral embolization of the internal iliac artery and contralateral external-to-internal iliac artery bypass grafting during endovascular aneurysm repair [J]. J Vasc Surg， 2011， 54(4)： 960-964.
9. Maleux G， Willems E， Vaninbroukx J， et al. Outcome of proximal internal iliac artery coil embolization prior to stent-graft extension in patients previously treated by endovascular aortic repair [J]. J Vasc Interv Radiol， 2010， 21(7)： 990-994.
10. Maldonado TS， Rockman CB， Riles E， et al. Ischemic complications after endovascular abdominal aortic aneurysm repair [J]. J Vasc Surg，2004，40(4)： 703-709，710.
11. Maleux G， Koolen M， Heye S， et al. Limb occlusion after endovascular repair of abdominal aortic aneurysms with supported endografts [J]. J Vasc Interv Radiol，2008， 19(10)： 1409- 1412.
12. Higashi Y， Miyazaki M， Goto C， et al. Sarpogrelate hydrochloride，a selective 5-hydroxytryptamine (2A) antagonist， augments autologous bone marrow mononuclear cell implantation-induced improvement in endothelium-dependent vasodilation in patients with critical limb ischemia [J]. J Cardiovasc Pharmacol， 2010，55(1)： 56-61.
13. Houkin K， Nakayama N， Nonaka T， et al. The 5-hydroxytryptamine 2A receptor antagonist sarpogrelate hydrochloride inhibits acute platelet aggregation in injured endothelium [J]. J Int Med Res， 2006， 34(1)： 65-72.
14. Shikata C， Nemoto M， Ebisawa T， et al. Effect of sarpogrelate on cardiovascular disorders [J]. Exp Clin Cardiol， 2011，16(3)： 75-76.
15. Kajiwara I， Soejima H， Miyamoto S， et al. Effects of additional treatment of sarpogrelate to aspirin therapy on platelet aggregation and plasma plasminogen activator inhibitor activity in patients with stable effort angina [J]. Thromb Res， 2011，128(6)：547-551.
16. Choi J， Kermode JC. New therapeutic approaches to combat arterial thrombosis： better drugs for old targets， novel targets， and future prospects[ J]. Mol Interv， 2011，11(2)： 111-123.
17. Nakamura E， Tanaka N， Kuwabara M， et al. Relative contribu中國普外基礎與臨床雜志2012 年1 月第19 卷第1 期 Chin J Bases ? 86 ? Clin General Surg, Vol. 19, No. 1, Jan. 2012tions of 5-hydroxytryptamine (5-HT) receptor subtypes in 5-HTinduced vasoconstriction of the distended human saphenous vein as a coronary artery bypass graft [J]. Biol Pharm Bull， 2011，34(1)： 82-86.
18. Horiuchi M， Okita K， Takada S， et al. Effects of oral singledose administration of sarpogrelate hydrochloride on saturation O2 of calf muscle during plantar flexion exercise [J]. Adv Exp Med Biol， 2010， 662： 531-536.
19. Kim KM， Kim H， Chi HS， et al. Comparison of antiplatelet potency of sarpogrelate， aspirin， and beraprost in healthy volunteers according to in vitro closure time [J]. Blood Coagul Fibrinolysis， 2010，21(3)：262-265.
20. Sun YM， Su Y， Jin HB， et al. Sarpogrelate protects against high glucose-induced endothelial dysfunction and oxidative stress [J]. Int J Cardiol，2011， 147(3)： 383-387.
21. Hiroshi M，Hiroshi S. Effects of the 5-HT2A antagonist sarpogrelate on walking ability in patients with intermittent claudication as measured using the walking impairment questionnaire [J]. Ann Vasc Dis， 2008， 1 (2)：102-110.
22. Kodama A， Komori K， Kajikuri J， et al. Chronic treatment of hydroxytryptamine type 2a receptor antagonist sarpogrelate hydrochloride modulates the vasoreactivity of serotonin in experimental rabbit vein grafts [J]. J Vasc Surg， 2009， 50(3)： 617-625.[ 23] Kodama A， Komori K， Hattori K， et al. Sarpogrelate hydrochloride reduced intimal hyperplasia in experimental rabbit vein graft [J]. J Vasc Surg， 2009，49(5)： 1272-1281.
23. Nishihira K， Yamashita A， Tanaka N， et al. Serotonin induces vasoconstriction of smooth muscle cell-rich neointima through 5-hydroxytryptamine 2A receptor in rabbit femoral arteries [J].J Thromb Haemost， 2008， 6(7)： 1207-1214.
24. Bir SC， Fujita M， Marui A， et al. New therapeutic approach for impaired arteriogenesis in diabetic mouse hindlimb ischemia[J]. Circ J， 2008， 72(4)： 633-640.[ 26] Shimizu T，Yamada Y，Tashita A，et al. Pharmacokinetic analysis of antiplatelet effect of sarpogrelate hydrochloride and its application to drug dosage regimen－ modeling based on reversible inhibition of 5-HT2 serotonergic receptor in the platelet membrane by sarpogrelate hydrochloride and its metabolite [J].Yakugaku Zasshi， 1999，19(11)：850-860.

《中國普外基礎與臨床雜志》

鹽酸沙格雷酯在腹主動脈瘤腔內修復術后防治臀肌和下肢缺血的初步觀察

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《中國普外基礎與臨床雜志》

鹽酸沙格雷酯在腹主動脈瘤腔內修復術后防治臀肌和下肢缺血的初步觀察

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