老年人心房纤颤现况调查及栓塞风险、出血风险评估  

Survey of atrial fibrillation in the elderly and embolic risk and bleeding risk assessment

作　　者：王必莲 陈慎 周珏 林霞 张琼 张晓芒 刘韵 郁莉 WANG Bilian;CHEN Shen;ZHOU Jue;LIN Xia;ZHANG Qiong;ZHANG Xiaomang;LIU Yun;YU Li(Wujiao Street Community Health Service Center,Yangpu District,Shanghai 200433,China)

机构地区：[1]上海市杨浦区五角场街道社区卫生服务中心,上海200433

出　　处：《公共卫生与预防医学》2018年第5期135-137,共3页Journal of Public Health and Preventive Medicine

基　　金：上海市杨浦区示范家庭医生培养项目立项重点课题(YP2017SQ002)

摘　　要：目的调查上海市杨浦区五角场街道(以下简称五角场街道)某居委老年人心房纤颤(AF)患病情况,评估栓塞、出血风险。方法对五角场街道某居委1 263例老年常住居民进行横断面调查,了解AF的患病情况、抗凝治疗情况、未抗凝的原因等,并采用CHA2DS2-VASc评分、HAS-BLED评分评估栓塞、出血风险。结果该地区老年人AF的患病率为5. 94%。随着年龄的增长,AF的患病率呈升高趋势(χ趋势2=16. 75,P <0. 001);随着年龄的增长,AF患者CHA2DS2-VASc评分、HAS-BLED评分均显著增加(F=42. 86,12. 98,P <0. 001);随着危险分级的增加,AF患者抗凝治疗的准确率依次升高(χ2=11. 53,P=0. 003);HAS-BLED评分<3分患者的出血转化率为10. 00%,显著低于HAS-BLED评分≥3分患者的出血转化率55. 56%(χ2=4. 55,P=0. 033);担心出血风险(50. 00%),无法按要求监测国际标准化比值(INR)(37. 50%)是未行抗凝治疗的主要原因。结论五角场街道某居委老年人AF患病率高,抗凝治疗未达指南要求。应进一步加强抗凝治疗宣教,提高抗凝治疗率及患者的依从性,同时建立基于CHA2DS2-VASc评分、HAS-BLED评分的栓塞及出血风险的评价体系以优化抗栓治疗。Objective To investigate the prevalence of elderly atrial fibrillation （ AF） and evaluate the risk of embolism and haemorrhage incertain Community of Wujiaochang Street in Yangpu District. Shanghai City （ hereafter referred to as Wujiaochang Street）. Methods 1 263 inhabitants in certain Community of Wujiaochang Street were Cross-sectional studied to understand the prevalence of elderly AF. the conditions of drug utilization of the anticoagulant drugs. cause of no anticoagulant. and the risk o fembolism and bleeding was evaluated by CHA2DS2 - VAS score.HAS - BLED score. Results The prevalence of elderly AF in this area was 5. 94%. which increase with the growth of age（ χMH2= 16. 75.P 〈 0. 001）. CHA2DS2 - VAS score. HAS - BLED score wasalso increase with the growth of age （ F = 42. 86. 12. 98.P 〈 0. 001 ）. With the increase of risk classification. the accuracy ofanticoagulant therapy in AF patients was also increased（χ^2= 11. 53. P = 0. 003）. The hemorrhagic transformation rate in the patientswith HAS - BLED score less than 3 was 10. 0%. which was significantly lower than 55. 56% in patients with HAS - BLED score morethan 3（ χ^2= 4. 55.P = 0. 033）. Worrying about risk of bleeding （50. 00%）. unable to monitor INR as required （37. 50%） was the main reason for the not anticoagulant therapy. Conclusions There is high prevalence of elderly AF incertain Community of Wujiaochang Street. low anticoagulant treatment fails to meet the requirements of guide. We should pay more attention to strengthen the administration of knowledge propaganda and education. improve the anticoagulant treatment and patient compliance. Establishment evaluation system of embolism and bleeding risk based on CHA2DS2 - VASc score. HAS - BLED score can contribute to optimize the antithrombotic therapy.

关 键 词：心房颤动 老年 栓塞 出血 风险评估 

分 类 号：R181.3[医药卫生—流行病学] R592[医药卫生—公共卫生与预防医学]