社区心房颤动患者抗凝治疗现状分析

Current Status of Anticoagulation Therapy for Patients with Atrial Fibrillation in Community

目的调查某社区心房颤动(房颤)患者抗凝治疗现状,分析社区房颤患者抗凝治疗的影响因素,为社区卫生服务中心开展针对性的健康教育和相关干预提供依据。方法调查上海市徐汇区某社区卫生服务中心2009年住院、家庭病床和门诊患者中的100例房颤患者,收集其发生血栓栓塞危险因素情况、抗凝药物使用情况,尤其是华法林抗凝应用情况。结果 100例房颤患者中48例(占48%)具有血栓栓塞性高危因素,38例(占38%)具有一项以上中危因素。共72例使用抗凝药物,其中7例使用华法林,华法林使用率仅为7%。对于无抗凝禁忌证的86例房颤患者,抗凝治疗正确率仅为12.79%。使用华法林抗凝组与其非华法林抗凝组在出血并发症发生率间差异无统计学意义(χ2=0.42,P>0.05)。对于未接受华法林治疗的原因分析中,患者担心服用后出血是最主要的原因(占32.26%)。结论社区应加强多种形式的针对房颤患者抗凝治疗知识的宣教,提高患者抗凝治疗的知晓率,进而推动社区房颤患者规范化的抗凝治疗。

Objective To investigate the current status of anticoagulation therapy for patients with atrial fibrillation（AF） in a community health service（CHS） center,and analyze its impacting factors so as to provide the basis for carrying out the target health education and the corresponding interventions in CHS centers.Methods Totally 100 AF inpatients,home based patients and outpatients from one of CHS centers in Xuhui District of Shanghai in 2009 were enrolled.And the information on risk factors of thromboembolism,usage of anticoagulation drug especially Warfarin was collected and analyzed.Results Totally 48 cases（48%） of 100 AF patients had high risk factors for thromboembolism,and 38 cases（38%） had more than one risk factors.Totally 72 patients（72%） were given anticoagulation therapy,but only 7（7%） were given Warfarin.The correct rate of anticoagulation therapy was 12.79% for 86 patients with no anticoagulation contraindication.For bleeding complication,there was no statistically significant difference between patients treated with Warfarin and other anticoagulation drugs（χ2=0.42,P0.05）.The main cause（accounting for 32.26%） for no acceptance of Warfarin was the patients′ fear of bleeding induced by Warfarin therapy.Conclusion Various approaches of AF training and education programs need to be enhanced so as to raise the AF patients′ awareness on anticoagulation therapy and promote the standard anticoagulation therapy.