老年心房颤动并发脑栓塞及抗凝治疗临床研究

Elderly atrial fibrillation and cerebral embolism and anticoagulant therapy clinical research

目的探讨老年房颤患者并发脑栓塞的危险因素以及抗凝治疗的现状。方法我们对2007年1月至2012年1月106例老年房颤患者的危险因素、超声心动图心脏附壁血栓发现率、抗凝治疗及脑梗死发生情况,同时观察心脏病无房颤患者及非心脏病无房颤患者脑梗死发生情况。结果 106例房颤患者中,病因以冠心病(59.43%)、高心病(11.32%)、心肌病(包括扩张性和肥厚性心肌病)5.66%为常见;超声心动图检查,于左心房发现附壁血栓3例;房颤组脑梗死发生率为35.8%,心脏病无房颤组脑梗死发生率为15.3%,而非心脏病无房颤组脑梗死发生率为3.8%;持续性房颤患者中未用或偶尔使用抗凝剂者和长期使用者脑梗死发生率分别为53.3%和35.7%。结论房颤是老年人脑梗死发生的危险因素之一,抗凝治疗能够降低这种危险。

Objective To investigate the risk factors of elderly patients with atrial fibrillation complica- ting brain embolism and current situation of anticoagulation therapy. Methods 0bzerve the risk factors, mural thrombus of heart, antieoagulation therapy and the occurrence of brain embolism in 106 cases of elderly patients with atrial fibrillation in 2007. 01-2012. 01. Contion the information of brain embolism in heart disease patients without atrial fibrillation and patients without both atrial fibrillation or heeart diease. Results In 106 patients with atrial fibrillation, common etiological factors are coronary heart disease（ 59.43% ）, hypertensive heart dis- ease （ 11.32% ） and cardiomyopathy （ Including dilated and hypertrophic cardiomyopathy） 5.66% ; Pari- enthrombus on left atrial was found in 3 cases with echocardiography. In atrial fibrillation group, cerebral infarc- tion occurred at a rate of 35.8%, in＇ heart disease patients without atrial fibrillation was 15.3%, but the rate was 3.8% in patients without both atrial fibrillation or heart diease. The incidence rate of brain infarction in dur- ative atrial fibrillation patients with unused or occasional used and long-term used of anticoagulants is 53.3% and 35.7%. Conclusion Atrial fibrillation is a risk factor of brain infarction in old person, anticoagulation therapy can reduce this risk.