抗栓疗法对≥80岁非瓣膜病心房颤动病人脑梗死的影响  

Effect of antithrombotic therapy on cerebral infarction in patients with advanced non-valvular atrial fibrillation

作　　者：蒋愈娇[1] 林慕如[2] 李东樱 JIANG Yu-jiao;LI Dong-ying;LIN Mu-ru(Department of Neurolog;Department of Cardiology,Hainan General Hospital,Haikou 570311,China)

机构地区：[1]海南省人民医院神经内科,海南省海口市570311 [2]海南省人民医院心内科,海南省海口市570311

出　　处：《实用老年医学》2018年第8期773-776,共4页Practical Geriatrics

摘　　要：目的探究抗栓疗法在≥80岁非瓣膜病心房颤动(房颤)病人脑梗死中的应用效果。方法回顾性分析2014年2月至2016年7月在我院接受治疗的88例非瓣膜病心房颤动病人,根据病人是否进行抗栓治疗及服用抗栓药物的情况将病人分为抗凝组、抗血小板组和对照组,比较不同抗栓方案的治疗效果,并对其影响因素进行分析。结果抗凝组脑梗死发生率为15.63%,抗血小板组为29.41%,对照组为54.55%,差异有统计学意义(P<0.05)。单因素分析结果显示,高血压、冠心病、糖尿病及慢性心功能不全、房颤时间和治疗方案与脑梗死有密切关联(P<0.05);多因素Logistic分析结果显示,高血压、冠心病、糖尿病、房颤时间是房颤后脑梗死的独立危险因素,OR(95%CI)分别为2.211(1.159~4.217),1.935(1.041~3.598),1.742(1.020~2.974),1.552(1.151~2.094)(P<0.05)。抗凝组皮肤瘀斑、牙龈/鼻出血、皮下血肿、上消化道出血事件发生率小于抗血小板组(P<0.05)。结论房颤时间是影响非瓣膜病心房颤动病人脑梗死的独立危险因素,抗凝治疗此类病人出血风险低,对脑梗死的发生具有保护作用,超高龄病人治疗中应以抗凝治疗为主。Objective To explore the effect of antithrombotic therapy on cerebral infarction in patients with advanced non-valvular atrial fibrillation. Methods A retrospective analysis of 88 patients with advance non-valvular atrial fibrillation who were treated in our hospital from February 2014 to July2016 was performed. The patients were divided into anticoagulant group,antiplatelet group and control group according to whether the patients were treated with antithrombotic therapy or antithrombotic drugs.Compared with the control group, the therapeutic effects of different antithrombotic therapy were compared and the influencing factors were analyzed. Results The incidence rate of cerebral infarction was 15. 63% in anticoagulant group,29. 41% in antiplatelet group and 54. 55% in control group（ P〈0. 05）. Univariate analysis showed hypertension,coronary heart disease,diabetes,chronic heart failure,atrial fibrillation time,therapeutic methods were the influencing factors of cerebral infarction（ P〈0. 05）.Multivariate Logistic analysis showed that hypertension,coronary heart disease,diabetes mellitus and atrial fibrillation time were independent risk factors for cerebral infarction after atrial fibrillation,OR（ 95%CI） were 2. 211（ 1. 159-4. 217）,1. 935（ 1. 041-3. 598）,1. 742（ 1. 020-2. 974）,1. 552（ 1. 151-2. 094） respectively（ P〈0. 05）. The incidence rate of skin freckle, gingival/nasal bleeding,subcutaneous hematoma,and upper gastrointestinal bleeding was lower in the anticoagulation group than that in the antiplatelet group（ P〈0. 05）. Conclusions Atrial fibrillation time is an independent risk factor influencing cerebral infarction in patients with advanced non-valvular atrial fibrillation.Anticoagulant therapy has a low risk of bleeding,which has a protective effect on cerebral infarction.Anticoagulant therapy should be used in the treatment of super-aged patients.

关 键 词：抗栓疗法 非瓣膜病心房颤动 脑梗死 

分 类 号：R541.75[医药卫生—心血管疾病]