2种治疗方法对非瓣膜病心房颤动患者抗凝的比较研究  

Comparing two anticoagulation therapys in patients with non-valvular atrial fibrillation

作　　者：周立英[1] 郭自同[1] 姚娟[1] 

机构地区：[1]新疆维吾尔自治区人民医院心内科,乌鲁木齐830001

出　　处：《新疆医科大学学报》2016年第9期1103-1105,1110,共4页Journal of Xinjiang Medical University

基　　金：新疆维吾尔自治区自然科学基金(2012211A085)

摘　　要：目的了解非瓣膜病心房颤动患者采用不同抗凝治疗方法的影响因素及安全性。方法收集2012年5月—2014年5月新疆维吾尔自治区人民医院明确诊断为非瓣膜病心房颤动的患者172例,根据美国心脏病学会/美国心脏协会/欧洲心脏病协会（ACC/AHA/ESC）心房颤动治疗指南评价其规范化抗凝情况,并采用血栓栓塞风险评分（CHADS2）及出血风险评分（HAS-BLED）对172例患者进行抗凝-出血风险评估。结果32例（18.6%）患者使用华法林抗凝,140例（81.4%）患者抗血小板治疗。其中血栓栓塞高危组106例（61.6%）患者中14例（13.2%）使用华法林治疗。华法林治疗的患者和抗血小板治疗的患者性别、CHA2DS2（0～1分）、出血事件差异无统计学意义（P〉0.05）,而高龄、CHA2DS2（≥2分）、HAS-BLED评分（≥3分）、合并疾病、栓塞事件上差异有统计学意义（P〈0.05）。结论非瓣膜病心房颤动患者使用华法林抗凝的比例低。高龄、合并疾病多,栓塞及出血风险评分高的患者选择抗血小板治疗,而性别、血栓栓塞风险评分低的患者及最后非致死性出血事件抗凝治疗和抗血小板治疗无差异。Objective By exploring anticoagulation status of patients with non-valvulalr atrial fibrillation in People′s Hospital of Xinjiang Uygur Autonomous Region,the existing risk factors of anticoagulant therapy and safety were analyzed.Methods 172 diagnosed with non-valvular atrial fibrillation cases who hospitalized in cardiology of People′s Hospital of Xinjiang Uygur Autonomous Region were collected.According to ACC/AHA/ESC atrial fibrillation treatment guidelines,the situation of normative anticoagulation were evaluated.And anticoagulated-bleeding risk were assessed by using the CHADS2 score and HAS-BLED bleeding risk score for these patients.Results 32patients（18.6%）ttook warfarin to anticoagulation and140patients（81.4%）used antiplatelet therapy.Among 106patients（61.6%）had high-risk of thromboembolism,only 14 patients took warfarin.Between two methods,gender,CHADS2（0-1）,incidence of bleeding had no difference.However,age,CHADS2（≥2）,HAS-BLED（≥3）,comorbidities,thromboembolism had remarkable difference（P〈0.05）.Conclusion Using Warfarin in patients with non-valvular atrial fibrillation accounted the low percentage.The elder patients had more comorbidities,high risk of thrombo-embolism and bleeding were used antiplatelet therapy.Grender,lower CHADS2,incidence of bleeding had no difference between two groups.

关 键 词：心房颤动 华法林 规范化抗凝治疗 血栓栓塞风险评分(CHADS2) 出血风险评分(HAS-BLED) 

分 类 号：R541.7[医药卫生—心血管疾病]