基层医院房颤患者抗凝治疗现状调查研究  

Investigation on Anticoagulation Treatment of Patients With Atrial Fibrillation in Primary Hospitals

作　　者：汪蓉 郑春美 武桂林[3] 赵顺春 张励文 WANG Rong;ZHENG Chunmei;WU Guilin;ZHAO Shunchun;ZHANG Liwen(Department of Cardiovascular Medicine,the First People's Hospital of Liangshan Yi Autonomous Prefecture,Liangshan Sichuan 615000,China;Department of Cardiovascular Medicine,Mianning County People's Hospital,Mianning Sichuan 615000,China;Department of Cardiovascular Medicine,Zhaojue County People's Hospital,Zhaojue Sichuan 615000,China)

机构地区：[1]凉山彝族自治州第一人民医院心血管内科,四川凉山615000 [2]冕宁县人民医院心血管内科,四川冕宁615000 [3]昭觉县人民医院心血管内科,四川昭觉615000

出　　处：《中国卫生标准管理》2023年第13期84-88,共5页China Health Standard Management

基　　金：凉山州科技计划重点研发项目(21ZDYF0118)。

摘　　要：目的调查分析基层医院房颤患者流行病学资料、抗凝治疗,实现房颤患者抗凝治疗率、房颤患者抗凝治疗有效率的提升提供可靠资料,从而促进房颤患者的规范化管理治疗。方法收集2019年1月—2020年12月在冕宁县人民医院及昭觉县人民医院内科住院部住院患者,根据纳入标准和排除标准,收集房颤患者的年龄、性别、栓塞风险评分、出血风险评分、抗凝治疗情况以及合并疾病等基本信息,分析房颤患者的流行病学资料及抗凝治疗现状。结果根据纳入、排除标准筛选后纳入359例房颤患者,平均年龄(70.5±12.3)岁,合并疾病前3位为冠心病(39.8%)、高血压(32.0%)、慢性肺病(17.5%)。所有房颤患者总体抗凝药物使用率为26.5%,11.9%房颤患者仅使用抗血小板药物治疗,仍有61.6%的房颤未给予抗凝或抗血小板治疗。抗凝患者中,93.7%的患者服用华法林抗凝治疗;风湿性心脏病房颤患者使用的抗凝药均为华法林。给予抗凝治疗组,年龄更小,合并更高比例的扩心病、风心病和心衰;而未给予抗凝治疗组,非瓣膜病性心房颤动患者发生脑卒中危险(CHA2DS2-VASc)评分、心房颤动抗凝治疗出血风险(HASBLED)评分显著更高,合并高血压、冠心病、脑卒中比例均更高。年龄更大的患者虽然出血风险增加,但栓塞风险同样增加,而这部分患者很大程度上未得到合理抗凝治疗。当CHA2DS2-VASc评分为2~5分时抗凝占比较高,CHA2DS2-VASc评分为6分时,抗病比例显著下降。结论本研究中基层医院房颤患者有效抗凝治疗率不足1/3,抗凝药物主要为华法林、非维生素K拮抗剂口服抗凝药(non-vitamin K antagonist oral antucoagulants,NOAC)使用率仅为6.3%;大部分房颤患者未得到合理规范的抗凝治疗。Objective To investigate and analyze the epidemiological data and anticoagulation therapy of patients with atrial fibrillation in primary hospitals,and to improve the anticoagulant therapy rate of patients with atrial fibrillation,so as to promote the standardized management and treatment of patients with atrial fibrillation.Methods Collection from January 2019 to December 2020 in Mianning County People's Hospital and Zhaojue County People's Hospital inpatient patients,according to the inclusion criteria and exclusion criteria,the age,gender,embolic risk score,bleeding risk score,anticoagulation,and combined diseases,the epidemiological data of the analysis and anticoagulation status of patients with atrial fibrillation.Results According to the inclusion and exclusion criteria,359 AF patients were included,with a mean age(70.5±12.3)years.And the first three combined diseases were 39.8%CAD,32.0%hypertension,and 17.5%chronic lung disease.Overall anticoagulant use in all patients with AF was 26.5%,11.9%of AF patients were treated with antiplatelet drugs alone,and 61.6%of AF were not given anticoagulation or antiplatelet therapy.Among anticoagulation patients,93.7%received warfarin anticoagulation;the anticoagulant drugs used in patients with rheumatic atrial fibrillation were warfarin.The anticoagulant group was younger,with a higher proportion of expanded heart disease,wind heart disease and heart failure;but in the anticoagulant group,non-valvular atrial fibrillation had stroke risk(CHA2DS2-VASc)score,significantly higher scores,and higher proportion of hypertension,coronary heart disease and stroke.Older patients have an increased risk of bleeding,but also an increased risk of embolization,and these patients are largely untreated without reasonable anticoagulation.When the CHA2DS2-VASc score was 2-5,and the CHA2DS2-VASc score was 6,the proportion of disease resistance decreased significantly.Conclusion In this study,the effective anticoagulation therapy rate of patients with atrial fibrillation in primary hospit

关 键 词：心房颤动 栓塞 卒中 华法林 新型口服抗凝药 抗凝治疗 

分 类 号：R541[医药卫生—心血管疾病]