329例非瓣膜性房颤患者抗栓治疗情况调查与分析  

Anticoagulation Treatment in 329 Patients with Non-Valvular Atrial Fibrillation

作　　者：杨渊 闫欣欣[1] 张宇 孙康云[1] 张茜[1] 徐桂冬[1] 朱静燕 YANG Yuan;YAN Xinxin;ZHANG Yu;SUN Kangyun;ZHANG Qian;XU Guidong;ZHU Jingyan(Suzhou MunicipalHospital Affiliated to Nanjing Medical University,Suzhou,Jiangsu,China 215008;Suqian First People′s Hospital,Suqian,Jiangsu,China 223899)

机构地区：[1]南京医科大学附属苏州医院·苏州市立医院,江苏苏州215008 [2]江苏省宿迁市第一人民医院,江苏宿迁223899

出　　处：《中国药业》2020年第18期37-39,共3页China Pharmaceuticals

基　　金：江苏省卫生计生委2018年度医学科研课题[Z2018015];江苏省苏州市2018年度科技发展计划项目[sysd2018244]。

摘　　要：目的了解同级医院心内科非瓣膜性房颤住院患者抗栓治疗现状。方法以苏州市立医院心内科2017年收治329例的非瓣膜性房颤住院患者为研究对象,参考美国心脏病学会/美国心脏协会/美国心律协会2014年发布的《心房颤动管理指南(》以下简称《指南》),通过CHA2DS2-VASc卒中评分系统和HAS-BLED出血评分系统对患者进行评估。参照2012年欧洲心脏病学会房颤治疗指南[5],评价华法林抗凝效果。比较患者实际抗栓治疗方案与指南推荐方案的差距。结果CHA2DS2-VASc评分方面,低危患者抗凝比例为100.00%,与《指南》推荐不符,存在过度抗凝;中危患者9例,6例(66.67%)采用抗凝治疗,3例(33.33%)采用抗血小板治疗,均符合《指南》推荐;高危人群中,267例(83.96%)按《指南》推荐接受抗栓治疗,51例(16.04%)未接受抗栓治疗;HAS-BLED评分方面,低危患者用药率为100.00%,高危患者用药率为69.09%。高危患者中有42例接受双抗治疗,其中38例为经皮冠状动脉介入手术(PCI)术后患者,符合2014年PCI指南[9]推荐;63例应用华法林抗凝,国际标准化比值(INR)达标率30.16%,接受抗栓治疗的278例患者中,出现ADR 7例(2.52%),出现心脑血管不良事件6例,未抗凝患者中出现心脑血管不良事件3例。结论该院非瓣膜性房颤患者抗凝治疗与相关指南推荐有较大差距,需进一步规范,完善华法林INR监测,做好随访和宣教。Objective To understand the current status of anticoagulant treatment for patients with non-valvular atrial fibrillation in the Department of Cardiology in hospitals of the same level.Methods A total of 329 hospitalized patients with non-valvular atrial fibrillation in 2017 in the Department of Cardiology of Suzhou Municipal Hospital were selected as the research subjects.All patients were graded by the CHA2 DS2-VASc stroke scoring system and HAS-BLED bleeding scoring system with reference to the 2014 Atrial Fibrillation Management Guidelines(hereinafter referred to as the Guidelines)issued by the American College of Cardiology/American Heart Association/American Heart Rhythm Society.The anticoagulant effect of warfarin was evaluated referring to the 2012 European Society of Cardiology ESC Atrial Fibrillation Treatment Guidelines.The gap between the actual antithrombotic regimen and the recommended guidelines was compared.Results There were 2 patients with low risk of stroke assessed by CHA2 DS2-VASc score.All of them received anticoagulant therapy and the anticoagulant ratio was 100.00%,which was not consistent with the recommendation of the guidelines and had excessive anticoagulation;of the 9 patients at middle risk of stroke,6(66.67%)were treated with anticoagulant therapy,3(33.33%)were treated with antiplatelet therapy,which was in line with the recommendations of the guidelines;among the high-risk patients,267 cases(83.96%)received antithrombotic therapy as recommended by the guidelines,51 cases(16.04%)did not receive antithrombotic therapy.In terms of HAS-BLED score,the medication rate for low-risk patients was 100.00%,and 69.09%for high-risk patients.Among the high-risk patients,42 received dual-antibody therapy,of which 38 were post-percutaneous coronary intervention(PCI)patients,which was in line with the 2014 PCI guidelines and recommendations.Warfarin was used for anticoagulation in 63 cases,and the international normalized ratio(INR)compliance rate was 30.16%;of the 278 patients receiving antithrombo

关 键 词：非瓣膜性房颤 抗凝治疗 卒中风险评分 出血风险评分 国际标准化比值 

分 类 号：R95[医药卫生—药学] R973.2