社区老年房颤患者抗凝治疗现状单中心横断面调查分析  

Cross-sectional Investigation on the Anticoagulation Therapy for Patients with Atrial Fibrillation in a Community

作　　者：许成燕 汤茜 魏新萍 黄冬[3] 宦红梅 XU Cheng-yan;TANG Qian;WEI Xin-ping(Gumei Community Health Srvice Cnter,Minhang Dstrict,Shanghai,Shanghai,221162,China)

机构地区：[1]上海市闵行区古美社区卫生服务中心,上海221122 [2]上海市闵行区梅陇社区卫生服务中心,上海201104 [3]上海交通大学附属第六人民医院,上海200233

出　　处：《中国初级卫生保健》2021年第1期88-90,共3页Chinese Primary Health Care

基　　金：上海市闵行区卫生和计划生育委员会科研课题立项项目(2017MWO4)。

摘　　要：目的:了解社区65岁及以上老年房颤患者抗凝治疗和社区随访情况,为进一步规范抗凝治疗提供理论基础和建议。方法:采用回顾性分析方法,入选2017—2018年本社区65岁及以上老年人心电图或动态心电图诊断房颤的166例患者,通过查阅居民电子健康档案、门诊随访和电话随访方式,记录性别、年龄、主要疾病诊断、CHA2DS2-VASc评分、抗凝治疗情况以及社区随访情况。结果:166例房颤患者中男性98例,女性68例,合并基础疾病比例由高到低分别为原发性高血压、冠心病、2型糖尿病、脑梗塞和瓣膜病。华法林或NOAC治疗率为27.7%,且随着年龄增大,抗凝治疗率降低(χ^2=144.02,P<0.001)。159例非瓣膜性房颤患者中,CHA2DS2-VASc评分≥2分的男性75例,使用华法林或NOAC药物22例;评分≥3分的女性44例,使用华法林或NOAC药物15例。166例老年房颤患者主要选择社区定期随访86例。在98例社区随访患者中,被宣教房颤知识及危害的48例,被建议抗凝的32例,被告知应用华法林或NOAC的有效性和安全性23例,被建议调整治疗方案15例,被转诊上级医院专科进一步规范治疗8例,行动不便代配药13例。结论:社区老年房颤患者合并多种慢性疾病,且随着年龄增大,规范抗凝治疗率越低。后续需要建立社区老年房颤患者规范随访路径,以推动社区老年房颤患者规范化抗凝治疗及管理。OBJECTIVE To investigate the anti coagulation therapy and community follow-up visit for patients of 65 years or older with atrial fibrillation in community,and provide the theoretical approaches and suggestions for further standardized anticoagulation therapy.METHODS The data of the electrocardiogram or holter of 166 atrial fibrillation patients of 65 years or older in target community from 2017 to 2018 were retrospectively analyzed.The gender,age,main diagnose,anticoagulantion therapy and community follow-up visit were recorded through electronic health records.Outpatient and phone follow-up before CHA2 DS2-VASc scores were calculated.RESULTS 166 atrial fibrillation patients were composed of 98 males and 68 females,with basic diseases of primary hypertension,coronary heart diseases,type 2 diabetes,cerebral infarction,and valvular disease.The treatment rate of warfarin or NO AC was only,which was decreased with the increase of age(χ~2=144.02,P<0.001).Among 159 patients of non-valvular atrial fibrillation,22 cases were treated with warfarin or NO AC in 75 males(scored above 2 points),while 15 cases were treated with warfarin or NO AC in 44 females(scored above 3 points).In 166 patients with atrial fibrillation,86 patients were followed up regularly in community.Among 86 cases of follow-up patients in the community,48 cases were taught about atrial fibrillation and its hazards,while 32 cases suggested to accept anticoagulantion therapy,23 cases were told the effectiveness and safey of warfarin or NOAC,15 cases were suggested to regulate treatment plan,8 cases transferred to the higher-level hospitals,and 13 cases prescribed with the help of others.CONCLUSION Community elderly patients with atrial fibrillation were complicated with a variety of chronic diseases,and the rate of treatment with warfarin or NO AC was decreased with the increase of age.It was necessary to establish a standard follow-up path for community elderly patients with atrial fibrillation,so as to promote standardized anticoagulation treatment an

关 键 词：老年房颤 抗凝治疗 规范化管理 

分 类 号：R591.7[医药卫生—内科学]