陕西关中地区县级医院非瓣膜性心房颤动患者的抗凝治疗现况及影响因素  

Current status and influencing factors of anticoagulant therapy in patients with nonvalvular atrial fibrillation in county-level hospitals of Guanzhong area,Shaanxi province

作　　者：张晓波 马娜 王艳 高洁 魏静华 何希站 康峰 曹磊 陈芝会 Zhang Xiaobo;Ma Na;Wang Yan;Gao Jie;Wei Jinghua;He Xizhan;Kang Feng;Cao Lei;Chen Zhihui(Department of Cardiology,Xingping People’s Hospital,Xingping 713100,China;Internal Medicine-Cardiovascular Department,BaoJi 409 Hospital,Baoji 721000,China;Department of Cardiology,Shaanxi Forest Industry Hospital,Xi’an 710300,China;Department of Cardiology,Qianxian People’s Hospital,Xianyang 713300,China;Department of Cardiology,Fufeng People’s Hospital,Baoji 722200,China;Department of Cardiology,Xunyi People’s Hospital,Xianyang 711300,China)

机构地区：[1]兴平市人民医院心血管一科,713100 [2]宝鸡市409医院心血管内科,721000 [3]陕西森工医院心内科,西安710300 [4]乾县人民医院心内科,咸阳713300 [5]扶风县人民医院心内科,宝鸡722200 [6]旬邑县人民医院心内科,咸阳711300

出　　处：《中国心血管杂志》2022年第3期284-288,共5页Chinese Journal of Cardiovascular Medicine

摘　　要：目的了解陕西关中地区县级医院非瓣膜性心房颤动(房颤)患者的抗凝治疗现况及影响因素。方法通过查询住院电子病历和门诊存档病历,采用临床资料分析、电话随访+面对面随访、问卷调查的方式,筛选出2019年1~12月于陕西关中地区8家县级医院心内科就诊的门诊和住院房颤患者,分析中高危栓塞风险患者的抗凝治疗现况、华法林和非维生素K拮抗剂口服抗凝药(NOACs)长期抗凝治疗依从性及影响因素。问卷调查心内科医生房颤患者的栓塞风险评估、抗凝药物选择、栓塞风险及抗凝获益宣教情况。结果共纳入房颤患者4577例,平均年龄(67.9±10.1)岁,其中男性2793例,女性1784例,门诊患者1968例,住院患者2609例。采用CHA 2DS 2-VASc评分,门诊抗凝治疗率为14.9%,住院抗凝治疗率为44.9%。华法林抗凝治疗1年依从性良好、一般、较差的患者比例分别为24.0%、26.7%、49.3%;NOACs抗凝治疗1年依从性良好、一般、较差的患者比例分别为32.7%、25.2%、42.1%。影响患者抗凝治疗依从性的主要因素:频繁监测凝血及国际标准化比值(INR)难以保持目标水平、过于担忧出血风险、经济因素、患者对可能面临的卒中风险认识不足、基层医生未告知或强调抗凝治疗的必要性和重要性。结论陕西关中地区县级医院非瓣膜性房颤患者抗凝率低、依从性差、抗凝治疗不规范、健康宣教不足,有待进一步规范和提高。Objective To investigate the current situation and influencing factors of anticoagulation therapy in patients with nonvalvular atrial fibrillation in county-level hospitals in Guanzhong area of Shaanxi Province.Methods By inquiring the electronic medical records of inpatients and the archived medical records of outpatients,patients with nonvalvular atrial fibrillation in cardiology department of 8 county-level hospitals in Guanzhong area of Shaanxi Province from January to December 2019 were screened and reviewed.The compliance and influencing factors of anticoagulant therapy with warfarin and non-vitamin K antagonist oral anticoagulants(NOACs)were analyzed.Results A total of 4577 patients with nonvalvular atrial fibrillation,aged(67.9±10.1)years were enrolled,including 2793 males and 1784 females,1968 outpatients and 2609 inpatients.According to CHA 2DS 2-VASc scoring system,the anticoagulation treatment rate of outpatients and inpatients was 14.9%and 44.9%,respectively.The proportion of patients with good,average and poor compliance of warfarin anticoagulation treatment for one year was 24.0%,26.7%and 49.3%respectively.The proportion of patients with good,average and poor compliance of NOACs anticoagulation treatment for one year was 32.7%,25.2%and 42.1%respectively.The main factors influencing the anticoagulant treatment compliance included frequent monitoring of coagulation and INR,difficulty in maintaining the target level,over worrying about bleeding risk,economic factors and lack of awareness of the possible risk of stroke.What is more,primary-level doctors may not inform or emphasize the necessity and importance of anticoagulant therapy to patients.Conclusions The anticoagulation rate of patients with nonvalvular atrial fibrillation in Guanzhong area of Shaanxi Province is relatively low and the compliance of patients is poor.The anticoagulation treatment is not standardized and the health education is not sufficient.The anticoagulation treatment of patients with nonvalvular atrial fibrillation needs to

关 键 词：非瓣膜性心房颤动 抗凝治疗 影响因素 

分 类 号：R541.75[医药卫生—心血管疾病]