中国急诊心房颤动患者心血管相关药物的应用和预后分析  

Application and prognosis analysis of cardiovascular-related medications in Chinese emergency patients with atrial fibrillation

作　　者：王娟[1] 张涛[1] 杨艳敏[1] 朱俊[1] 张晗[1] 邵兴慧[1] Wang Juan;Zhang Tao;Yang Yanmin;Zhu Jun;Zhang Han;Shao Xinghui(Emergency and Intensive Care Center of Cardiology,Fuwai Hospital,State Key Laboratory of Cardiovascular Disease,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院,北京协和医学院,国家心血管病中心,心血管疾病国家重点实验室,阜外医院心内科急重症中心,100037

出　　处：《中国心血管杂志》2022年第5期422-428,共7页Chinese Journal of Cardiovascular Medicine

基　　金：首都临床诊疗技术研究及示范应用(Z191100006619121);阜外院所青年基金(2022FWQN18)。

摘　　要：目的探讨心血管相关药物在中国急诊心房颤动(房颤)患者中的应用情况和对临床结局事件的影响。方法连续入选2008年11月至2011年10月在全国20家医院急诊科就诊的房颤患者,收集患者基线资料和心血管用药治疗情况。根据心血管药物应用数量,将患者分为多重用药(≥5种心血管药物)组和无多重用药(<5种心血管药物)组;进行1年随访,主要终点事件为全因死亡、心血管死亡和再入院。应用单因素和多因素logistic和Cox回归模型分析上述事件的独立危险因素。结果本研究共入选2015例房颤患者,平均心血管药物数量(3.4±1.9)种,多重用药患者570例(28.3%)。与无多重用药患者相比,多重用药患者的体质指数、血压和CHA 2DS 2-VASc评分更高,吸烟史、永久性房颤、冠心病、高血压、心力衰竭和糖尿病的比例更高(均为P<0.05)。多因素logistic回归分析显示,舒张压(OR=1.013,95%CI:1.004~1.023)、阵发性和永久性房颤(OR=1.424,95%CI:1.037~1.956;OR=1.588,95%CI:1.183~2.132)、高血压(OR=2.484,95%CI:1.912~3.226)、冠心病(OR=2.489,95%CI:1.965~3.152)和心力衰竭(OR=3.168,95%CI:2.518~3.985)为房颤患者多重用药的预测因素(均为P<0.05)。多重用药组1年随访的再入院事件显著多于无多重用药组(均为P<0.05),两组其他终点事件比较无统计学差异。多重用药(OR=1.431,95%CI:1.142~1.795)、睡眠呼吸暂停(OR=1.720,95%CI:1.034~2.862)、2型糖尿病(OR=1.428,95%CI:1.093~1.865)和心力衰竭(OR=1.962,95%CI:1.581~2.432)是房颤患者再入院的独立危险因素(均为P<0.05)。本研究中房颤患者未应用抗凝药治疗的独立预测因素包括高血压、冠心病、慢性阻塞性肺疾病和抗血小板治疗;而在多重用药患者中,冠心病和抗血小板治疗为未应用抗凝药治疗的独立预测因素。结论多重心血管相关用药在中国急诊房颤患者中较为普遍,是房颤患者1年随访再入院的独立危险因素,但对死亡、卒中�Objective To investigate the application of cardiovascular-related drugs in Chinese emergency patients with atrial fibrillation(AF)and their impact on clinical outcomes.Methods The patients with AF in Emergency Department in 20 hospitals across the country from November 2008 to October 2011 were consecutively enrolled.The baseline data and drug treatment status of the patients were collected and followed up for 1 year.The main endpoints were all-cause death,cardiovascular death and re-hospitalization.Univariate and multivariate logistic and Cox regression models were used to analyze independent risk factors for the above events.Results A total of 2015 patients with AF were included in this study.The average number of cardiovascular-related drugs was 3.4±1.9,and 570(28.3%)patients with polypharmacy.Compared with patients without polypharmacy,patients with polypharmacy had higher body mass index,blood pressure,and CHA 2DS 2-VASc score;and higher proportion of smoking history,permanent AF,coronary artery disease(CAD),hypertension,heart failure(HF)and diabetes(all P<0.05).Multivariate logistic regression analysis showed that diastolic blood pressure(OR=1.013,95%CI:1.004-1.023),paroxysmal and permanent AF(OR=1.424,95%CI:1.037-1.956;OR=1.588,95%CI:1.183-2.132),hypertension(OR=2.484,95%CI:1.912-3.226),CAD(OR=2.489,95%CI:1.965-3.152),and HF(OR=3.168,95%CI:2.518-3.985)were independent predictors of polypharmacy(all P<0.05).The re-admission events of the polypharmacy group were significantly higher than those without polypharmacy,and there was no significant difference in other endpoint events between the two groups.Polypharmacy(OR=1.431,95%CI:1.142-1.795),sleep apnea(OR=1.720,95%CI:1.034-2.862),diabetes(OR=1.428,95%CI:1.093-1.865),HF(OR=1.962,95%CI:1.581-2.432)were independent risk factors for re-hospitalization(all P<0.05).In this study,the independent predictors for anticoagulants non-use included hypertension,CAD,chronic obstructive pulmonary disease,and antiplatelet therapy;while in patients with polypharmacy,CAD and

关 键 词：多重用药 心房颤动 急诊 再入院 死亡 卒中 抗凝治疗 

分 类 号：R541.75[医药卫生—心血管疾病]