单中心心力衰竭合并房颤病例回顾性分析

Retrospective Analysis of Hospitalized Cases with Chronic Heart Failure Complicated with Atrial Fibrillation in Single-central Hospital

目的了解心房纤颤(AF)在慢性心力衰竭(CHF)住院患者中的构成比例及其原发病因构成比例随时段的变化,同时调查相关临床资料以及抗栓药物治疗状况。方法入选1983—2002年CHF患者,年龄≥45岁1180例,合并AF440例,每5a为1个时段,采用回顾性分析的方法,对原始数据做统计学分析。结果AF在CHF患者中占37.3%,其构成随时段推移逐渐增加,经χ2检验,差别有统计学意义(χ2=8.88,P=0.003)。AF的原发病因构成依次为冠状动脉粥样硬化性心脏病(CHD)59.7%、风湿性心脏病(RHD)18.6%、肺源性心脏病(PHD)9.7%、高血压性心脏病(HHD)4.4%、扩张性心脏病(DCM)3.4%。其中,CHD的构成随时段呈增加的趋势(P<0.01),PHD、HHD构成随时段呈减少的趋势,差别均有统计学意义(P<0.01)。在CHF患者中,AF伴同缺血性脑卒中病史、心内血栓、并发栓塞的构成比例高于无AF(P<0.01)。CHF合并AF患者阿司匹林使用率为51.6%(227/440),华法林使用率为8.6%(38/440)。结论AF在CHF患者中所占比例高,构成比例随时段增加。在CHF患者中,CHD是AF最常见的原发病因。提示未来抗凝治疗有待加强。

Objective To understand the trend of the constituent ratio of atrial fibrillation （AF） and primary etiology in hospitalized cases with chronic heart failure （CHF） and complicated with AF in late 20 years. Methods 1 180 patients with CHF （thereinto, 440 complicated with AF） were selected from the hospitalized cases during the past 20 years （1983-2002）, and a retrospective analysis was performed with every 5 years interval. Results The constituent ratio of AF in the general cases with CHF was 37.3%, and it was higher in females than in males （41.3% vs 33.4%, P〈0.01）. With time going, the trend of constituent ratio of AF in cases with CHF increased gradually and significantly every five-year-duration （X^2=-8,88, P〈0.01）. The primary etiology of AF in cases with CHF was coronary heart disease （CHD, 59.7%）, rheumatic heart disease （RHD, 18.6%）, pulmonary heart disease （PHD; 9.7%）, etc, The trend of constituent ratio of CHD gradually increased, but PHD decreased with time （X^2=2A.79;P〈0.001）. The history rates of ischemic cerebral stroke, cardiac cavity thrombus and embolism in cases with AF was higher than those in cases without AF （P〈0.001）. The usage rate of aspirin was 51.6%, and warfarin was 8.6%. Conclusions The constituent ratio of AF in cases with CHF was high, and there was a increased trend of it with time, CHD was the most common primary cause for CHF cases complicated with AF, and its constituent ratio also increased with time. The anti-coagnlant agents should be intensified in future days.