替罗非班在治疗破裂颅内动脉瘤中的研究进展

doi:10.12092/j.issn.1009-2501.2026.01.012

摘要/Abstract

摘要：

破裂颅内动脉瘤是一种高致死率和高致残率的脑血管急症，虽然支架辅助弹簧圈栓塞术有效，但术中血栓形成和术后出血等并发症问题依然突出。替罗非班作为一种强效的血小板聚集抑制剂，以其迅速起效、半衰期短且血小板功能可快速恢复等特点，在破裂颅内动脉瘤治疗中显示出潜力。本综述通过总结替罗非班的药理学机制及其临床应用，分析其在不同剂量下的疗效与安全性，并探讨其在术前预防性用药和术中挽救性治疗中的合理用药策略。此外，本文还重点讨论了替罗非班在治疗破裂颅内动脉瘤中的挑战与局限，提出了未来研究方向，以期为替罗非班的标准化应用提供循证支持，提升其在神经介入治疗中的应用价值。

关键词: 替罗非班, 破裂颅内动脉瘤, 支架辅助弹簧圈, 血流导向装置, 低剂量

Abstract:

Ruptured intracranial aneurysm is a cerebrovascular emergency with high mortality and morbidity. Although stent-assisted coil embolization is effective, complications such as intraoperative thrombosis and postoperative bleeding remain prominent issues. Tirofiban, a potent platelet aggregation inhibitor, with its rapid onset, short half-life, and quick recovery of platelet function, shows potential in the treatment of ruptured intracranial aneurysms. This review summarizes the pharmacological mechanisms of tirofiban and its clinical applications, analyzes its efficacy and safety at different doses, and explores its rational use in preoperative prophylaxis and intraoperative salvage therapy. Furthermore, the review discusses the challenges and limitations of using tirofiban in the treatment of ruptured intracranial aneurysms and proposes future research directions. The goal is to provide evidence-based support for the standardized application of tirofiban and enhance its value in neurointerventional therapy.

Key words: tirofiban, ruptured intracranial aneurysm, stent-assisted coil, flow diverter, low dose

中图分类号:

R543.1

杨立, 郑治, 孟旭峰, 刘倩, 郝云飞. 替罗非班在治疗破裂颅内动脉瘤中的研究进展[J]. 中国临床药理学与治疗学, 2026, 31(1): 107-115.

Li YANG, Zhi ZHENG, Xufeng MENG, Qian LIU, Yunfei HAO. Research progress of tirofiban in the treatment of ruptured intracranial aneurysms[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2026, 31(1): 107-115.

图/表 2

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研究/团队	样本量（n）	给药方案	并发症	主要发现
Lee等^[48]	50	静脉负荷0.4 μg·kg^?1·min^?1（30 min），随后25 μg/kg维持23.5 h	5例血栓形成，2例延迟出血事件	高剂量有效抑制血小板聚集，但与延迟出血风险相关
Li等^[49]	46	静脉负荷10 μg/kg（3 min），随后 0.1 μg·kg^?1·min^?1维持12 h	2例术后血栓事件，2例胃肠道出血	较低的血栓事件发生率，但仍有出血事件发生
梁晓东等^[50]	175	静脉负荷8 mg/kg（3 min），随后 0.1 mg·kg^?1·min^?1维持	6例血栓栓塞事件，4例替罗非班相关出血事件	中等剂量显示一定疗效，但伴随较高出血风险
王子良等^[38]	128	静脉负荷8 mg/kg（3 min），随后 0.1 mg·kg^?1·min^?1维持	5例血栓事件，未见明显出血事件	安全性较高，血栓事件发生较少
Sayin等^[51]	16	静脉负荷8 mg/kg（3 min），随后 0.1 mg·kg^?1·min^?1维持	2例血栓形成	样本量较小，但表明中等剂量使用安全
马一辉等^[52]	105	静脉负荷5 μg/kg，随后0.06～ 0.08 μg·kg^?1·min^?1维持6～8 h	无出血事件，3例血栓栓塞事件	低剂量替罗非班安全有效，未发生出血并发症
闫亚洲等^[53]	309	标准组：静脉负荷10 μg/kg（3 min），随后0.15 μg·kg^?1·min^?1维持6～8 h；半剂量组：静脉负荷5 μg/kg（3 min），随后0.075 μg·kg^?1·min^?1维持6～8 h	15例血栓栓塞事件（标准组：11例，半剂量组：4例），13例出血事件（全部为标准剂量组）	标准剂量组血栓和出血发生率较高，半剂量组较低
沈咣晨等^[39]	72	静脉负荷5 μg/kg（1 min），随后 0.1 μg·kg^?1·min^?1维持	4.17%的血栓并发症，1例出血并发症	低剂量方案显示出良好的血栓控制效果，出血事件较少
Kim等^[15]	41	静脉负荷0.4 μg·kg^?1·min^?1（30 min），随后0.1 μg·kg^?1·min^?1维持	无出血事件	低剂量替罗非班有效且无出血并发症

研究/团队	样本量（n）	给药方案	并发症	主要发现
Lee等^[48]	50	静脉负荷0.4 μg·kg^?1·min^?1（30 min），随后25 μg/kg维持23.5 h	5例血栓形成，2例延迟出血事件	高剂量有效抑制血小板聚集，但与延迟出血风险相关
Li等^[49]	46	静脉负荷10 μg/kg（3 min），随后 0.1 μg·kg^?1·min^?1维持12 h	2例术后血栓事件，2例胃肠道出血	较低的血栓事件发生率，但仍有出血事件发生
梁晓东等^[50]	175	静脉负荷8 mg/kg（3 min），随后 0.1 mg·kg^?1·min^?1维持	6例血栓栓塞事件，4例替罗非班相关出血事件	中等剂量显示一定疗效，但伴随较高出血风险
王子良等^[38]	128	静脉负荷8 mg/kg（3 min），随后 0.1 mg·kg^?1·min^?1维持	5例血栓事件，未见明显出血事件	安全性较高，血栓事件发生较少
Sayin等^[51]	16	静脉负荷8 mg/kg（3 min），随后 0.1 mg·kg^?1·min^?1维持	2例血栓形成	样本量较小，但表明中等剂量使用安全
马一辉等^[52]	105	静脉负荷5 μg/kg，随后0.06～ 0.08 μg·kg^?1·min^?1维持6～8 h	无出血事件，3例血栓栓塞事件	低剂量替罗非班安全有效，未发生出血并发症
闫亚洲等^[53]	309	标准组：静脉负荷10 μg/kg（3 min），随后0.15 μg·kg^?1·min^?1维持6～8 h；半剂量组：静脉负荷5 μg/kg（3 min），随后0.075 μg·kg^?1·min^?1维持6～8 h	15例血栓栓塞事件（标准组：11例，半剂量组：4例），13例出血事件（全部为标准剂量组）	标准剂量组血栓和出血发生率较高，半剂量组较低
沈咣晨等^[39]	72	静脉负荷5 μg/kg（1 min），随后 0.1 μg·kg^?1·min^?1维持	4.17%的血栓并发症，1例出血并发症	低剂量方案显示出良好的血栓控制效果，出血事件较少
Kim等^[15]	41	静脉负荷0.4 μg·kg^?1·min^?1（30 min），随后0.1 μg·kg^?1·min^?1维持	无出血事件	低剂量替罗非班有效且无出血并发症

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