老年非瓣膜性房颤复律和长期抗凝治疗的新型社区干预策略评估  

Evaluation of Novel Community Intervention Strategy Towards Cardioversion and Long-term Anticoagulation Treatment of Non-valvular Atrial Fibrillation in the Elderly

作　　者：冉华 何艺 王正中 王丽 牟江涛 瞿家权 Ran Hua;He Yi;Wang Zhengzhong(Department of Cardiology,Department of Science and Education and Laboratory Medicine,Qianjiang Central Hospital of Chongqing City,Qianjiang District,Chongqing 409000;Department of Medical Imaging,Jishou University,Jishou,Hunan 416000,China)

机构地区：[1]重庆市黔江中心医院心内科,科教科,检验科,重庆黔江区409000 [2]吉首大学医学影像系,湖南吉首416000

出　　处：《四川医学》2018年第12期1350-1355,共6页Sichuan Medical Journal

基　　金：重庆市科委科研课题(编号:cstc2015shms-ztzx0027);吉首大学独立设置实验(实训)课程建设项目(编号:JDDL2016001)

摘　　要：目的探讨医联体联合互联网+社区干预对重庆市偏远山区老年非瓣膜性房颤复律和长期抗凝治疗的有效性和安全性。方法 2013年1月至2016年12月,我们收集重庆市黔江中心医院心内科收治的的渝东南偏远山区需长期抗凝治疗的老年非瓣膜性房颤患者58例和同期对照组门诊随访的老年非瓣膜性房颤患者37例,我们依托医联体系统为基础,采用实时便捷的微信通讯技术和房颤管理及响应事件识别继续教育培训以及远程会诊和决策响应系统系统,对老年非瓣膜性房颤患者长期抗凝治疗和房颤复律进行社区干预,并对其有效性和安全性进行评估,收集数据并统计分析。结果纳入研究的95例老年非瓣膜性房颤患者,社区干预组患者抗凝达标率(64. 3%)与对照组(66. 8%)无显著差异(χ~2=1. 259,P=0. 275),而百例患者*年标化的一级响应和二级响应出血事件发生率(6. 90%,64. 3%)均低于对照组(93. 1%,100. 0%),出血事件构成比无显著性差异(χ~2=0. 013,P=1. 000);社区干预组患者的心率控制率、复律率、血栓事件发生率、6月内再入院率与对照组比较无显著差异(P>0. 05);社区干预组患者2月内再入院率显著低于对照组(χ~2=5. 854,P=0. 020)。结论医联体联合互联网+社区干预对老年非瓣膜性房颤患者长期抗凝治疗和房颤复律治疗具有与门诊随访相似的有效性和安全性,有助于探索边远山区少数民族老年非瓣膜性房颤患者的全程监控、及时响应和可及性高的社区干预型抗凝治疗。Objective To investigate the effectivity and safety of medical alliance Internet in combination with community intervention in the cardioversion and long-term anticoagulation treatment of non-valvular atrial fibrillation in the elderly in remote mountainous area of Chongqing. Methods 58 cases of elderly patients from remote mountainous area of southeast Chongqing,with non-valvular atrial fibrillation requiring long-term anticoagulation treatment,received by cardiology department of Qianjiang central hospital of Chongqing City from January 2013 to December 2016 and 37 cases of elderly patients with non-valvular atrial fibrillation followed up in outpatient department in the corresponding period as control group,were selected.Based on medical alliance,through timely and convenient wechat communication technology,continuing education training of atrial fibrillation management and response event identification,and remote consultation and decision response system,community intervention of cardioversion and long-term anticoagulation treatment of elderly patients with non-valvular atrial fibrillation were conducted.Statistics were collected and analyzed so that its effectivity and safety could be evaluated. Results Among the 95 elderly patients with non-valvular atrial fibrillation,compliance rate of anticoagulation showed no statistically significant difference(X^2=1.259, P =0.275)between community intervention group(64.3%)and control group(66.8%).Incidence of bleeding events with first class response and second class response every 100 patients standardized by year in community intervention group(6.90%,64.3%)was lower than that of control group(93.1%,100.0%),and proportion of bleeding events showed no statistically significant difference between the two groups(X^2=0.013, P =1.000).There was no statistically significant difference in heart rate control rate,cardioversion rate,incidence of thrombotic events and readmission rate within 6 months between the two groups( P >0.05).Readmission rate within 2 months in communit

关 键 词：非瓣膜性房颤 老年人 抗凝达标率 安全性 社区干预 

分 类 号：R541.75[医药卫生—心血管疾病]