心房颤动相关危险因素及药物治疗研究新进展

New progress in the treatment of atrial fibrillation and drug related risk factors

心房颤动是最常见的一种心律失常,可能引起血栓、栓塞、中风、心衰,甚至猝死。本文就近年来心房颤动相关的危险因素和药物研究进展进行综述。心房颤动的危险因素主要有:年龄大于65岁,心脏疾病或手术史,腹型肥胖,酗酒,呼吸系统疾病或感染,栓塞,代谢综合征,甲状腺功能亢进,糖尿病,低钾血症,抗心律失常药物,糖皮质激素,抗胆碱药物,排钾利尿剂,胆碱能药物等。对心房颤动患者的治疗首先应尽快复律,复律可以选择抗心律失常药物治疗,也可以选择电复律,应注意在解除房颤的同时预防室性心律失常。由于房颤后有较高的血栓和栓塞风险,应及时给予规范化抗凝治疗,而抗凝药物的长期使用往往易增加出血风险,尤其是颅内出血和大出血风险,在使用时应严格检测患者血清凝血指标。而抗凝药物的不断更新换代也逐渐出现优于传统抗凝药物的新型抗凝剂,将有助于临床房颤患者的长期抗凝治疗。

Atrial fibrillation is the most common type of arrhythmia that can cause thrombosis,embolism,stroke,heart failure,and sudden death.This review summarized the risk factors associated with atrial fibrillation and drug research progresses.The main risk factors for atrial fibrillation included older than65 years,history of heart disease or surgery,abdominal obesity,alcohol abuse,respiratory disease or infection,embolism,metabolic syndrome,hyperthyroidism,diabetes,hypokalemia,antiarrhythmic drugs,glucocorticoids,anticholinergic drugs,potassium row diuretics,cholinergic drugs and so on.Cardioversion therapy for patients with atrial fibrillation should be the first treatment as soon as possible,the therapy may choose anti-arrhythmic drugs,and also DC cardioversion.Accompany with cardioversion therapy,prevention of ventricular arrhythmias should also be paid attention.Due to the higher risk of thromboembolism and embolization after atrial fibrillation,standardized anticoagulant therapy should be given in time.However,the long-term use of anticoagulant drugs tends to increase the risk of bleeding,especially the risk of intracranial hemorrhage and major bleeding,thus,patients should be tested strictly for serum Blood coagulation index.The new anticoagulants that are more effective and safer than the traditional anticoagulant gradually emerge,which is beneficial to long-term anticoagulation after atrial fibrillation.