965例高龄老年房颤患者临床特点及抗凝治疗分析  

Clinical analysis of elderly patients with atrial fibrillation clinical characteristics and anticoagulation therapy: 965 cases report

作　　者：佟翠艳[1] 季瑞芬[1] 李春辉[1] 

机构地区：[1]沈阳军区总医院干部病房一科,辽宁沈阳110016

出　　处：《创伤与急危重病医学》2016年第2期91-94,共4页Trauma and Critical Care Medicine

摘　　要：目的研究高龄老年心房颤动(AF)患者的特点及抗凝治疗情况,分析目前抗凝治疗中存在的问题。方法回顾性分析2010年1月至2015年10月住院的高龄AF患者的临床资料,评估高龄老年AF的血栓及出血风险,分析抗凝用药情况、抗凝治疗情况及不良反应。结果高龄老年AF患者合并症多,血栓危险分级及抗凝出血评分较高。本组965例患者卒中风险评估系统(CHA2DS2-VASc)评分标准≥2分,均应进行抗凝治疗。HASBLED评分≥3分患者522例(54.1%),抗凝出血风险高的患者所占比例较高。目前,高龄老年AF患者的临床抗凝治疗比例仍较低,自2010年—2015年波动于40%左右,抗凝治疗比例没有明显增加。不同科室抗凝治疗比例有明显差异,心内科及干部病房抗凝比例最高。抗凝药物随指南改变有所变化,在高龄老年患者中,逐渐应用口服达比加群及利伐沙班进行抗凝治疗。结论还需进一步普及AF教育,使患者及医师提高对AF的认识,从而提高AF患者的抗凝治疗比例,新型口服抗凝药物在高龄老年患者中的应用还需要临床不断积累经验,剂量尚需进一步探讨。Objective To investigate the characteristics of elderly patients with atrial fibrillation（ AF） and analysis of anticoagulant therapy with existing problems. Methods A retrospective study was performed on 965 cases of elderly patients with AF received from January 2010 to October 2015. The thrombosis and bleeding risks were assessed,anticoagulant medications and adverse reactions were analyzed. Results There were more complications in elderly patients with AF. The thrombosis risk classification（ CHA2DS2-VASc） scores and the anticoagulant bleeding scores（ HASBLED） were higher. All patients＇（ CHA2DS2-VASc） score≥2,anticoagulant therapy should be performed. The HASBLED score≥3 in 522 cases（ 54. 1%）,and there were high proportion of the patients with higher risk in anticoagulant bleeding thrombosis. At present,the clinical anticoagulant therapy ratio in elderly patients with AF is still low,the fluctuation since 2010 to 2015 was around 40% without apparent increases. There were statistically differences in different departments,the proportions of anticoagulant theropy in cardiology and the cadre ward were higer. Anticoagulant therapy changes were following guideline,Dabigatran and Rivaroxaban were applied gradually. Conclusion The education of AF needs to be further popularized in order to improved understanding of AF in doctors and patients,thus increase proportion of anticoagulant therapy in patients with AF. The clinical experience of new oral anticoagulant drugs in elderly patients is needed to be constantly accumulated and the dose is still needed to be further studied.

关 键 词：高龄老年 心房颤动 临床特点 抗凝 新型口服抗凝药 

分 类 号：R541.75[医药卫生—心血管疾病]