老年非瓣膜性心房纤颤的伴随疾病和节律控制的状况分析  

Status of accompaniment diseases and rhythm control in elderly patients hospitalized with nonvalvular atrial fibrillation

作　　者：徐军[1] 缪东培[1] 包知达[1] 殷宇刚[1] 王莉[1] 张凯[1] 肖继明[1] 吕磊[1] 

机构地区：[1]南京军区南京总医院心内科,江苏南京210002

出　　处：《医学研究生学报》2006年第11期1013-1015,共3页Journal of Medical Postgraduates

摘　　要：目的:研究因非瓣膜性心房纤颤(房颤)住院的老年患者的伴随疾病及心律和心室率控制的状况。方法:回顾性分析12余年住院患者的240例资料,分析其房颤病程和伴随的疾病,药物治疗和起搏治疗的情况,心率和心律的变化。结果:合并心力衰竭、传导系统病变和脑卒中者分别为57.1%、31.7%和20.4%。对房颤病程不清楚者在阵发性房颤中占13.9%、在持续性房颤中占20.1%。在阵发性房颤中单独应用普罗帕酮(心律平)、β受体阻滞剂、胺碘酮治疗者分别占37.6%、25.7%和21.8%,用两种以上药物治疗者占14.9%,有7.9%的患者自行转复为窦性心律。在持续性房颤中单用地高辛、β受体阻滞剂、非二氢吡啶类钙拮抗剂治疗者分别占57.6%、23.7%和7.2%,用两种以上药物治疗者占10.8%,有20.1%的患者无需用药物控制心室率。有10.9%的阵发性房颤患者和14.4%的持续性房颤患者均行VVI起搏,主要原因分别为病态窦房结综合征和Ⅱ度以上房室传导阻滞。结论:老年非瓣膜性房颤常伴随心力衰竭、传导系统疾病和脑卒中,部分患者未及时发现和治疗房颤,大部分阵发性房颤单用普罗帕酮、β受体阻滞剂或胺碘酮可转复为窦性心律,在持续性房颤患者中,有57.6%用地高辛、20.1%不用控制心率的药物就可维持心室率。阵发性房颤和持续性房颤的起搏指征和方式均有待商榷。Objective：To investigate current situation of rhythm control and rate control on nonvalvular atrial fibrillation （AF） in elderly person. Methods：Retrospective analysis was carried out in 240 patients hospitalized during 12 years, AF history and complicated symptoms, drug treatments, pacemaker implantation, and rhythm and rate changes were among statistic items. Results：Heart failure, conduction system abnormality, stroke were found in 57.1% , 31.7 % , and 20.4 % of patients respectively, 13.9% of paroxysmal AF and 20.1% of persistent AF failed to be detected timely. Propafenone, betablockers, or amiodarone alone were prescribed to control rhythm of paroxysmal AF at percentage of 37.6 % ,25. 7 % , or 21. 8 % , respectively. In persistent AF, digoxin, beta-blockers, and calcium channel blockers were taken at percentage of 57.6 % ,23.7 % , and 7.2 % , respectively. VVI pacing was performed in 10.9 % of paroxysmal AF complicated mainly with sick sinus syndrome and in 14.4% of persistent AF complicated with grade Ⅱ or Ⅲ AVB. Conclusion ： Heart failure, conduction abnormality＇, and stroke were the most common complicated diseases in nonvalvular AF of the elderly. Some patients were not sensitive to rhythm and rate changes due to AF, which could lead to serious results. The rhythm-control strategy was mainly performed in paroxysmal AF with the drug choice of propafenone, beta-blockers and amiodarone, rate-control treatment was ordered in persistent AF with digoxin taken by over half of the patients, in about one-fifth patients the drugs were not needed for controlling ventricular rate. AF-preventable pacing method remains to be chosen in paroxymal AF, pacing indications, pacing sites and sophisticated measures should be taken into account to deal with conduction abnormalities and cardiac function in persistent AF.

关 键 词：心房纤颤 心率 心律 非瓣膜性 老年 

分 类 号：R514.75[医药卫生—内科学]