单中心瓣膜性心房颤动患者脑卒中二级预防院内及随访结果分析  

Clinical characteristics,secondary prevention of stroke and follow-up survey of patients with valvular atrial fibrillation related stroke:a single center observational study

作　　者：王子盾[1] 吴楠 张廉[2] 高小媛 杨贻兰 郦明芳[1] 万琪[2] 曹克将[1] 陈明龙[1] Wang Zidun;Wu Nan;Zhang Lian;Gao Xiaoyuan;Yang Yilan;Li Mingfang;Wan Qi;Cao Kejiang;Chen Minglong(Department of Cardiology,The First Affiliated Hospital with Nanjing Medical University,Nanjing,210029,China;Department of Neurology,The First Affiliated Hospital with Nanjing Medical University,Nanjing,210029,China)

机构地区：[1]南京医科大学第一附属医院心血管内科,210029 [2]南京医科大学第一附属医院神经内科,210029

出　　处：《中华心律失常学杂志》2021年第6期510-514,共5页Chinese Journal of Cardiac Arrhythmias

基　　金：江苏省科技厅-社会发展-临床前沿项目(BE2017750)。

摘　　要：目的了解神经内科脑卒中合并瓣膜性心房颤动(VAF)患者的诊疗现状、临床特点、脑卒中二级预防情况及预后。方法入选2013年1月至2017年12月南京医科大学第一附属医院神经内科所有出院患者,并筛选其中脑卒中合并VAF患者。回顾性收集患者的完整临床资料,并调查出院时抗凝处方情况,并于2019年初,通过电话询问方式随访所有患者或家属,调查患者出院后至随访时的预后情况,包括全因死亡、脑卒中再复发率、出院后的抗凝治疗情况。结果2013年1月至2017年12月,南京医科大学第一附属医院神经内科共出院患者7860例,其中确诊为脑卒中合并VAF患者38例(男18例,女20例)。患者年龄(63.9±10.9)岁,CHA2DS2-VASc评分(3.9±1.4)分,HAS-BLED评分(2.1±0.9)分。其中18例为风湿性心脏瓣膜病但未行瓣膜置换术,余20例为风湿性心脏病人工瓣膜置换术后。出院时总抗凝人数为30人,抗凝率为78.9%(30/38)。2019年初,通过电话随访获知38例患者中死亡11例,死亡率为28.9%(11/38);存活的27例中,随访时抗凝率为100%。结论神经内科住院治疗的脑卒中患者中,VAF检出率低。脑卒中合并VAF患者的脑卒中二级预防抗凝管理仍不理想,全因死亡率较高。这类患者相对年轻,危险因素较少,但重症比例高。Objective To investigate the current status of diagnosis and treatment,the clinical characteristics,the secondary prevention of stroke,and the prognosis of patients with valvular atrial fibrillation(VAF)related stroke in neurology department.Methods All patients discharged from the neurology department of the First Affiliated Hospital with Nanjing Medical University from January 2013 to December 2017 were enrolled in the study.Depending on the inclusion criteria,patients with VAF related stroke were screened from the enrolled population.Related clinical information was collected retrospectively,especially the anticoagulation prescription situation at discharge.And in early 2019,all patients or their relatives were followed up by telephone inquiry to investigate their prognosis including all-cause mortality,the posthospital re-stroke rate,and the usage of anticoagulation after hospital discharge.Results From January 2013 to December 2017,a total of 7860 patients were discharged from the neurology department of the First Affiliated Hospital with Nanjing Medical University,and of whom 38 cases were diagnosed as VAF related stroke.Thirty-eight patients(18 males,20 females)were at mean age(63.9±10.9)years,average CHA2DS2-VASc score(3.9±1.4),and HAS-BLED score(2.1±0.9).Eighteen among them were diagnosed as rheumatic valvular heart disease without valve replacement,the other 20 patients were rheumatic valvular heart disease post prosthetic valve replacement.Thirty patients(78.9%,30/38)were prescribed anticoagulation agents at discharge.In early 2019,all 38 patients or their relatives were followed up by telephone inquiry,with 11 died and 27 survived.All 27 survivors were adherent to anticoagulation therapy at follow-up.Conclusion Stroke patients admitted in the neurology department were characterized as low detection rate of VAF.They had unsatisfactory secondary prevention of stroke,and high all-cause mortality.Although patients of VAF related stroke were relatively young and associated with fewer risk factors,they m

关 键 词：心房颤动 脑卒中 抗凝治疗 二级预防 

分 类 号：R541.75[医药卫生—心血管疾病] R743.3[医药卫生—内科学]