心房纤颤住院患者262例病因诊断误区分析

Diagnostic Pitfalls of Etiopathogenisis of Atrial Fibrillation:Report of 262 Cases

目的对262例心房纤颤(房颤)住院患者的病因进行回顾分析,探讨房颤的病因构成及病因诊断误区,为提高其诊治水平提供参考。方法采用回顾性分析,选取2011-03-01—2012-03-01于辽宁医学院附属第一医院心内科住院的262例房颤患者为研究对象。入院诊断为冠状动脉粥样硬化性心脏病(冠心病)138例(52.7%)、高血压病67例(25.6%)、风湿性心脏病25例(9.5%)、预激综合征4例(1.5%)、房颤28例(10.7%)。依据患者病史、症状、查体、生化检查、甲状腺功能、血气分析、心电图、超声心动图及冠状动脉造影等进行病因分析。结果对262例房颤患者的病史、症状、查体、实验室检查等资料进行回顾分析。入院诊断为冠心病的138例患者中,出院确定诊断为冠心病65例(47.1%),误诊病例73例,误诊率52.9%。入院诊断为高血压病的67例患者中,出院确定诊断为高血压40例(59.7%),误诊病例27例,误诊率40.3%。262例房颤患者出院确诊为老年性房颤87例(33.2%)、风湿性心脏病27例(10.3%)、肺心病12例(4.6%)、甲状腺功能亢进9例(3.4%)、预激综合征8例(3.0%)、孤立性房颤7例(2.7%)、饮酒3例(1.1%)、其他4例(1.5%)。在出院确定诊断冠心病、高血压病的患者中,年龄>65岁者分别为57例(87.7%)、28例(70.0%)。结论老年性房颤、冠心病、高血压为房颤的主要病因。房颤病因诊断误区:(1)将房颤的器质性心脏病病因扩大化;(2)忽视心外疾病引起的房颤;(3)正常人可出现房颤。

Objective To explore the etiological composition of atrial fibrillation （AF） and its diagnostic pitfalls to provide base for improvement of diagnosis and treatment. Methods A retrospective analysis was carried out in 262 AF patients admitted to First Affiliated Hospital of Liaoning Medical College from March 1 2011 to March 1 2012. Admission diagnoses con firmed 138 patients as atherosclerotie coronary heart disease （CHD） （52.7%）, 67 as hypertension （25.6%）, 25 as rheumatic heart disease （RHD） （9. 5% ）, 4 as preexcitation syndrome （1.5%）, 28 as AF （10. 7% ）. Pathogenesis was analyzed based on patients＇ history, symptoms, physical examinations, biochemical tests, thyroid function, blood gas analysis, electrocardio gram, echoeardiography and coronary angiography. Results In 138 CHD patients by admission diagnoses, only 65 were diag nosed as CHD on discharge （47. 1% ）, with a misdiagnosis rate of 52.9% （73 cases）; in 67 hypertension patients, 40 （59. 7% ） as hypertension witha misdiagnosis rate of 40. 3% （27 eases）. In 262 AF patients, 87 were diagnosed as senile AF on discharge （33.2%）, 27 as RHD （ 10. 3% ）, 12 as pulmonary heart disease （4. 6% ）, 9 as hyperthyroidism （3.4%）, 8 as preexcitation syndrome （3.0%） , 7 as lone atrial fibrillation （2.7%） , 3 due to alcohol consumption （ 1.1% ） , 4 due to other causes （ 1.5% ）. In patients diagnosed as CHD and hypeSension on discharge, 57 CHD and 28 hypertension were over 65 years old. Conclusion Senile AF, CHD and hypertension are the main causes of AF. Its etiological diagnostic pitfalls include ： （ 1 ） Magnification of AF structural etiopathogenisis ; （2） Ignorance of AF caused by non cardiac diseases ; （ 3 ） Probable AF pres ence in normal subjects.