某基层三级医院NVAF抗凝治疗现状调查及影响因素分析  

Current Status and Influencing Factors of NVAF Anticoagulation Therapy in a Tertiary Hospital

作　　者：梁丽菊 王怀斌 杨子萱[1] Liang Liju;Wang Huaibin;Yang Zixuan(Department of Clinical Pharmacy,Baoshan People’s Hospital,Baoshan,Yunnan,678099,China)

机构地区：[1]云南省保山市人民医院临床药学科,云南保山678099 [2]保山中医药高等专科学校,云南保山678000

出　　处：《黑龙江医学》2025年第4期482-485,共4页Heilongjiang Medical Journal

基　　金：云南省教育厅科学研究基金项目(2023J0922)。

摘　　要：目的:探索滇西某基层三级医院非瓣膜性房颤(NVAF)抗凝治疗现状,并分析未进行抗凝治疗的影响因素。方法:通过医院信息管理系统调取2020年1月-2021年12月于保山市人民医院诊断为NVAF的861例患者的临床资料,根据患者是否接受抗凝治疗将其分为抗凝治疗组(n=317)和非抗凝治疗组(n=544)。提取两组患者的一般资料、抗凝治疗情况、CHA_2DS_2-VASc-60评分、HAS-BLED评分等,分析医院抗凝治疗现状,采用logistic回归分析探讨未进行抗凝治疗的影响因素,探索解决此问题的方法。结果:共纳入861例NVAF患者,采集纳入患者的CHA_2DS_2-VASc-60评分,830例患者有抗凝指征,抗凝治疗率为38.07%,280例患者仅使用抗血小板治疗,264例未采用抗凝或抗血小板治疗。logistic回归分析结果显示,患者未在心内科住院、未患有血管疾病、联合使用抗血小板药物、HAS-BLED评分高都是NVAF患者未进行抗凝治疗的影响因素(OR=4.183、2.028、0.469、1.252,P<0.05)。结论:该院NVAF患者总体抗凝治疗率较低,应逐步建立抗凝治疗管理团队,形成临床药师与临床医师相合作的模式,推动抗凝治疗向规范化治疗发展,降低房颤卒中的发生率及由此引发的致残率和病死率。Objective:To explore the current status of anticoagulant treatment for non-valvular atrial fibrillation(NVAF)in a tertiary hospital in western Yunnan Province,and analyze the influencing factors of non-anticoagulant treatment.Methods:861 patients with NVAF from January 2020 to December 2021 in Baoshan People’s Hospital of Yunnan Province were selected through HIS,and they were divided into anticoagulant group(n=317)and non-anticoagulant group(n=544).The general data,anticoagulant treatment situation,CHA2DS2-VASc-60 score and HAS-BLED score of the patients were extracted,retrospective analysis was used to analyze the current status of anticoagulant therapy in primary care.The influencing factors of the absence of anticoagulant treatment were discussed by multivariate logistic regression analysis,and the methods to solve this problem were explored.Results:Among 861 NVAF patients,CHA2DS2-VASc-60 score was done,830 patients had anticoagulation indication,and the rate was 38.07%.280 patients only received antiplatelet treatment,and 264 didn’t receive anticoagulation and antiplatelet treatment.Logistic regression analysis showed that no hospitalization in the department of cardiology,no vascular disease,combined use of antiplatelet drugs,and high HAS-BLED score were all influential factors for NVAF patients not receiving anticoagulation therapy(OR=4.183,2.028,0.469,1.252;P<0.05).Conclusion:The overall rate of anticoagulation therapy in NVAF patients in the hospital is low.It is necessary to gradually establish a management team of anticoagulation therapy and form a model of clinical pharmacists and clinicians to promote the development of standardized anticoagulation therapy for patients with atrial fibrillation,so that NVAF patients can receive the most appropriate anticoagulation therapy,and reduce the incidence of atrial fibrillation stroke and the disability rate and mortality.

关 键 词：非瓣膜性房颤 抗凝治疗 现状调查 多因素分析 

分 类 号：R541.75[医药卫生—心血管疾病]