心房颤动急诊患者的现状调查

Retrospective Analysis of 944 Atrial Fibrillation Patients in Emergency Room

目的:探讨心房颤动(房颤)急诊患者的病因、临床特点及治疗现状。方法:对我院2006-01至2006-12在急诊就诊的房颤患者按时间均衡抽样后,随机选择944例患者对其年龄、房颤史、原发疾病、超声心动图及抗心律失常、抗凝等用药情况进行回顾性分析。结果:入选944例房颤患者中,年龄为15～97岁,男女比例1∶0.88;房颤病因中,<45岁年龄段、45～64岁年龄段的最常见病因为风湿性心脏病,≥65岁年龄段患者的常见病因为高血压,全部944例患者最常见病因为风湿性心脏病。944例患者中孤立性房颤为200例(21.2%)。非瓣膜性房颤患者中,阵发性房颤患者左心房直径均显著小于持续性房颤和永久性房颤患者(P均<0.001),左心室射血分数显著高于持续性房颤和永久性房颤患者(P均<0.001),差异均有统计学意义。阵发性房颤患者心功能Ⅱ-Ⅳ级所占比例较持续性房颤和永久性房颤患者均明显减少(P均<0.001),差异均有统计学意义。全部房颤患者的药物治疗方面,使用β阻滞剂404例(42.7%),地高辛389例(41.2%),非二氢吡啶钙拮抗剂163例(17.3%),胺碘酮59例(6.3%),IC类药物54例(5.7%)。全部患者中合并血栓栓塞者79例(8.4%),其中使用华法林抗凝者有23例(29.1%)。瓣膜性房颤患者中用华法林抗凝有160例(48.2%);非瓣膜性房颤患者中用华法林抗凝有43例(7.1%)。结论:急诊房颤患者的病因、临床特点与国内一般人群的情况基本相似,药物治疗中以控制心室率为主;血栓栓塞是房颤重要的并发症,抗凝治疗需要进一步加强。

Objective ：To retrospectively analyze the clinical characteristics and treatment of atrial fibrillation （AF） patients in emergency room in our hospital. Methods：The clinical data of 944 AF patients treated in the emergency room of our hospital in 2006 were selected and analyzed retrospectively. Results：The enrolled patients＇ age were 19-97 years old, male to female ratio was 0 88： 1. The primary pathogenic cause of AF was rheumatic heart disease, the second and third causes were hypertension and coronary artery disease respectively. About 20% of patients had lone AF. In non-valvular AF patients, the left atrium diameter in paroxysmal AF patients was smaller than in persistent AF and permanent AF patients （P 〈 0. 001 respectively）. The left ventrieular ejection fraction and cardiac function were both higher in paroxysmal AF patients than in persistent AF and permanent AF patients （P 〈 0.001 respectively）. For all the enrolled patients ,79 （ 8.4% ） cases combined with thromboembolism including ischemic stroke and systemic embolism and 23 （29. 1% ） of those patients were treated with warfarin. Conclusion ：The pathogenic causes and clinical characteristics for AF patients selected in our emergency room were similar to the results from other studies. The rate-control strategy was the most common treatment. Thromboembolism was a significant morbidity in AF, it was necessary to emphasize the importance of anticoagulation therapy.