80岁以上老年心房颤动患者Barthel指数与口服抗凝治疗的相关性研究  

Relationship between Barthel index and oral anticoagulation therapy in elderly AF patients aged>80 years

作　　者：郭倩玉[1] 赵园媛[1] 卢成志[1] Guo Qianyu;Zhao Yuanyuan;Lu Chengzhi(Department of Cardiology,Tianjin First Central Hospital,Tianjin 300192,China)

机构地区：[1]天津市第一中心医院心内科,300192

出　　处：《中华老年心脑血管病杂志》2021年第11期1174-1176,共3页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的探讨Barthel指数与80岁以上老年心房颤动(房颤)患者抗凝治疗的相关性。方法选择高龄房颤患者136例,根据出院时是否口服抗凝药物分为抗凝组69例和非抗凝组67例。采用Barthel指数评价自理能力,依照Barthel指数4个分位分为4个级别,其中自理能力1级(<60分)31例,2级(60~75分)40例,3级(76~95分)34例,4级(>95分)31例。记录患者合并症、CHA_(2)DS_(2)-VASc评分、HAS-BLED评分、估算的肾小球滤过率、N末端B型钠尿肽前体水平及口服抗血小板药物情况,多因素logistic回归分析抗凝治疗的相关影响因素。结果与非抗凝组比较,抗凝组Barthel指数明显升高[(80.8±19.4)分vs(65.9±26.7)分,P<0.01],口服抗血小板药物明显减少(37.7%vs 71.6%,P<0.01)。Barthel指数1、2、3、4级患者口服抗凝药物分别为8例(25.8%)、19例(47.5%)、24例(70.6%)和18例(58.1%),差异有统计学意义(P<0.01)。多因素logistic回归分析显示,Barthel指数高、未服用抗血小板药物为促进抗凝药物使用的独立影响因素(P<0.05,P<0.01)。结论高龄患者Barthel指数可能是抗凝治疗决策的重要影响因素,老年房颤患者管理中应注重自理能力的评估和改善。Objective To study the relationship between BI and oral anticoagulation therapy in elderly AF patients aged>80 years.Methods One hundred and thirty-six elderly AF patients were divided into anticoagulation group(n=69)and non-anticoagulation group(n=67)according to whether they received oral anticoagulans at discharge.Their selfcare ability was assessed according to the BI.The patients were further divided into grade 1 selfcare ability group(n=31),grade 2 selfcare ability group(n=40),grade 3 selfcare ability group(n=34)and grade 4 selfcare ability group(n=31)according to their BI score.The incidence of complications,CHA_(2)DS_(2)-VASc score,HAS-BLED score and administered oral antiplatelet drugs in different groups were recorded.The eGFR and serum NT-proBNP level were measured.The influencing factors of anticoagulant therapy for elderly AF patients were analyzed by multivariate logistic regression analysis.Results The BI score was significantly higher while the ratio of administered antiplatelet drugs was significantly lower in anticoagulation group than in non-anticoagulation group(80.8±19.4 vs 65.9±26.7,P<0.01;37.7%vs 71.6%,P<0.01).Of the 136 elderly AF patients,8(25.8%),19(47.5%),24(70.6%)and 18(58.1%)received oral anticoagulants(P<0.01).Multivariate logistic regression analysis showed that high BI and no use of antiplatelet drugs were independent risk factors for the application of oral anticoagulants in elderly AF patients(P<0.05,P<0.01).ConclusionBI is a major influencing factor of anticoagulation therapy for elderly AF patients,attention should thus be paid to the assessment and improvement of their selfcare ability.

关 键 词：心房颤动 抗凝药 肾小球滤过率 老年人 80以上 

分 类 号：R541.75[医药卫生—心血管疾病]