住院心力衰竭患者合并心房纤颤的回顾性分析

Hospitalized patients with chronic heart failure complicated by atrial fibrillation:retrospective analysis of 1180 cases

目的分析近20年慢性心力衰竭(CHF)住院患者合并心房纤颤(AF)的构成比例及相关疾病随时段的变化趋势,栓塞情况,抗栓治疗状况。方法入选近20年(1983-2002年)CHF患者(年龄≥45岁)1180例(合并AF440例),每5年为一个时段,采用回顾性分析的方法。结果总体CHF患者中,合并AF的比例为37.3%,女性多于男性(1.18/1),且随着时段的推移而显著增加(趋势χ2=8.88;P<0.01)。CHF合并AF合并相关疾病的比例依次为冠状动脉粥样硬化性心脏病(CHD)、风湿性心脏病(RHD)、高血压病(HT)、糖尿病(DM)、扩张性心脏肌病(DCM)、肺源性心脏病(PHD)。CHD、HT、DM在CHF合并AF患者中的比例随时段呈显著增加的趋势(P<0.05)。而PHD在CHF合并AF患者中的比例随时段呈显著减少的趋势(P<0.01)。CHD合并HT、CHD合并DM和CHD、HT合并DM是CHF合并AF最常见的多个相关疾病组合。CHF合并AF发生栓塞为21例(占4.8%),使用阿司匹林治疗227例(51.6%),使用华法林治疗38例(8.6%)。结论AF随着时段的推移,该比例呈增加的趋势。注重CHD、HT、DM的早期防治,对于预防CHF合并AF的发生有十分重要的价值。

Objectives To explore the trend of the constitutent ratio of atrial fibrillation （AF） in hospitalized cases of chronic heart failure （CHF）, and to analyse the change of the related diseases, embolism and state of anti-embolus treatment of these patients. Methods A total of 1 180 hospitalized cases of CHF （440 complicated with AF） were enrolled during the past 20 years （1983-2002）. Every five years were regarded as a period and retrospective analysis was performed. Results The incidence of AF in all cases of CHF was 37.3%, and was higher in females than in males （1.18/1）. It increased gradually as time went by （χ^2=8. 88; P〈0. 01）. The rates of related diseases in cases of CHF complicated by AF in turn were coronary heart disease （CHD, 43.0%）, rheumatic heart disease （RHD, 42.5 %）, hypertension （HT, 35.9%）, diabetes rnellitus （DM, 13%）, dilated cardiomyopathy （DCM, 4. 1%） and pulmonary heart disease （PHD, 3.9%）. The rates of CHD, HT and DM in cases of CHF complicated by AF increased markedly （P〈0.05）, while that of PHD decreased markedly （P〈0.01） with progression of time periods. CHD and HT, CHD and DM, CHD, HT and DM were the most common combination of multiple related diseases. There were 21 cases complicated by embolism （4. 8% ）. The rate of using aspirin was 51.6% and that of warfarin was 8.6%. Conclusions The proportion of AF in cases of CHF was high, and increased significantly as time went by. Paying much attention to the prevention and treatment of CHD, HT and DM in early stage is very important for prevention of AF in cases of CHF.