华法林预防老年非瓣膜性心房颤动患者血栓栓塞临床研究

The antithrombotic effects and safety of warfarin in elder patients with nonvalvular atrial fibrillation

目的 探讨华法林对预防老年非瓣膜性心房颤动患者发生血栓栓塞的影响.方法 选择2010年8月至2011年8月诊治的老年非瓣膜性心房颤动患者92例,按照治疗方案不同分为观察组和对照组,每组46例,对照组给予阿司匹林治疗,观察组给予华法林治疗,观察比较两组患者血栓栓塞发生情况.结果 两组患者左房内径、左室收缩末期内径、左室舒张期内径、左室射血分数比较差异无统计学意义（P＞0.05）.观察组临床终点事件（短暂性脑缺血发作、脑栓塞、外周血管栓塞、左房附壁血栓及死亡）发生率为6.52％（3/46）,对照组为26.09％（12/46）,两组比较差异有统计学意义（x2=6.4519,P=0.0111）.观察组服药期间不良反应发生率为10.87％（5/46）,对照组为6.52％（3/46）,两组比较差异无统计学意义（P＞0.05）.结论 采用华法林能够降低老年非瓣膜性心房颤动患者血栓栓塞发生率,但是患者出血并发症值得关注,应密切关注患者国际标准化比值的变化.

Objective To explore the effect of warfarin in prevention of elderly patients with nonvalvular atrial fibrillation thromboembolism.Methods A total of 92 elderly patients with nonvalvular atrial fibrillation from August 2010 to August 2011 were enrolled,and according to the different treatment were divided into observation group and control group,with 46 cases in each group.Control group was given aspirin therapy,observation group was given warfarin therapy,and thromboembolism occurrence were recorded.Results The left atrial diameter,left ventricular systolic diameter,left ventricular diastolic diameter and left heart ejection fraction difference between two groups was not statistically significant （P ＞ 0.05）.The terminal event rates （transient ischemic attack,cerebral embolism,peripheral embolism,left atrial thrombi and death） in observation group were statistically lower than those in control group [6.52％ （3/46） vs.26.09％ （12/46）] （x2 =6.4519,P =0.0111）.The incidence of adverse reactions in observation group was 10.87％（5/46）,in control group was 6.52％（3/46）,and there was no statistically significant difference （P＞ 0.05）.Conclusions Warfarin can reduce the incidence of elderly patients with nonvalvular atrial fibrillation thromboembolism,but bleeding complications in patients should be concerned with,and international normalized ratio changes of the patients should be paid close attention to.