不同心房颤动筛查方式在社区老年人中的效果研究  

Analysis of the Effectiveness of Different Atrial Fibrillation Screening Methods in the Community-based Elderly Population

作　　者：石玉霜 王惠华 李艳 陆萍 宋玮 潘桂俊 SHI Yushuang;WANG Huihua;LI Yan;LU Ping;SONG Wei;PAN Guijun(Department of General Practice,Jinyang Community Health Service Center of Pudong New Area,Shanghai 200136,China)

机构地区：[1]上海市浦东新区金杨社区卫生服务中心全科医学科,200136

出　　处：《中国全科医学》2024年第11期1316-1319,1325,共5页Chinese General Practice

基　　金：上海市浦东新区卫健委卫生基金资助(PW2022A-16)。

摘　　要：背景老年人是心房颤动(简称房颤)的高危人群,提高社区老年人群房颤的筛查效率有助于降低房颤相关脑卒中的发生风险。目的比较不同的房颤筛查方式在老年人群中的筛查效率。方法于2022年7月—2023年1月选取上海市浦东新区金杨社区香山、黄山、罗山3个居委会的老年人1300例,先后使用触诊桡动脉脉搏、具有房颤检测功能的电子血压计、单导联心电记录仪进行房颤筛查,三者任一项阳性即为房颤阳性,最后由心电图室医生进行心电图检查并判读(诊断金标准)。绘制不同筛查方法的受试者工作特征(ROC)曲线,计算ROC曲线下面积(AUC),并评估其筛查价值;采用趋势性χ^(2)检验分析房颤卒中评分(CHA_(2)DS_(2)-VASc评分)与房颤之间的相关性。结果1300人中共检出房颤93人,其中无症状者57人;触诊脉搏阳性375人,具有房颤检测功能的电子血压计阳性331人,单导联心电记录仪检测阳性128人。触诊脉搏、具有房颤检测功能的电子血压计、单导联心电记录仪诊断社区老年人房颤价值的AUC分别为0.750(95%CI=0.697~0.803,P<0.01)、0.832(95%CI=0.790~0.874,P<0.01)、0.939(95%CI=0.906~0.973,P<0.01)。随着CHA_(2)DS_(2)-VASc评分增加,老年人房颤发生率逐渐增多(χ^(2)_(趋势)=197.46,P<0.01)。结论运用便携式单导联心电仪筛查房颤便捷、高效、准确,可推广用于社区老年人房颤的筛查。Background Older adults are at high risk for atrial fibrillation(AF).Improving the efficiency of AF screening among the community-based elderly population can help to reduce the risk of AF-related stroke.Objective To compare the screening efficiency of different AF screening methods in the elderly population.Methods A total of 1300 cases of older adults were selected from three neighborhood committees of Xiangshan,Huangshan,and Luoshan in Jinyang Community,Pudong New Area,Shanghai from July 2022 to January 2023.AF screening was detected using palpation of radial artery pulse,electronic sphygmomanometer with AF detection function,and single-lead ECG recorder.A positive result of any one of the three methods was considered positive for AF,and finally an electrocardiogram(ECG)was performed and interpreted by a physician in the ECG room.The receiver operating characteristic(ROC)curves of the subjects with different screening methods were plotted,the area under the ROC curve(AUC)was calculated to evaluate the screening value;the association between AF stroke score(CHA_(2)DS_(2)-VASc score)and AF was analyzed using the chi-square test for trend.Results AF was detected in 93 of the 1300 people,including 57 asymptomatic people;375 people had a positive palpated pulse,331 people had a positive electronic blood pressure monitor with AF detection function,and 128 people had a positive result of single-lead ECG recorder.The AUCs for the diagnostic value of palpation pulse,electronic sphygmomanometer with AF detection function and single-lead ECG recorder in the elderly was 0.750(95%CI=0.697-0.803,P<0.01),0.832(95%CI=0.790-0.874,P<0.01),0.939(95%CI=0.906-0.973,P<0.01);the incidence of AF in the elderly gradually increased as the CHA_(2)DS_(2)-VASc score increased(χ^(2)_(trend)=197.46,P<0.01).Conclusion Screening for AF using single-lead ECG recorder is convenient,efficient and accurate,and can be promoted in AF screening among community-based elderly population.

关 键 词：心房颤动 老年人 社区 触诊 血压计 心电记录仪 CHA2DS2-VASc评分 筛查 

分 类 号：R541.75[医药卫生—心血管疾病]