心房颤动926例抗凝状况分析

Analysis of anticoagulation in 926 patients with atrial fibrillation

目的 分析心房颤动（以下简称房颤）患者抗凝状况.方法 对926例房颤患者的抗凝治疗情况进行回顾性分析,旨在总结经验,提高对房颤的抗凝认识.结果 在926例房颤患者中,有675例患者未进行抗凝治疗,占72.89%;而仅有251例患者进行了抗凝治疗,占27.11%.年龄〉75岁患者中仅有66例进行抗凝治疗,占33.17%.在合并冠心病患者中17.60%患者进行抗凝治疗,合并糖尿病患者中28.37%患者进行抗凝治疗,合并高血压患者中28.32%患者进行抗凝治疗,合并心功能不全患者中30.77%患者进行抗凝治疗.年龄〉75岁、高血压、冠心病、临床医师的治疗策略以及患者对治疗的选择都是华法林使用情况的影响因素,但是其中只有年龄〉75岁、冠心病、患者选择治疗因素等三个因素差异有统计学意义（OR=7.02、12.73、4.79,P〈0.05）.675例未抗凝治疗患者中101例患者因无华法林抗凝治疗指征而未使用华法林进行抗凝治疗,占14.96%;另外,有574例AF患者有华法林抗凝治疗指征而未用华法林抗凝治疗,分析其原因：63例有抗凝禁忌证,172例为医生过分担心出血并发症,440例患者不能按照要求检测INR.结论 在基层医院AF患者应用华法林抗凝治疗严重不足,应提高广大基层医务人员与患者对房颤并发栓塞的危险性的认识,做好对患者的宣教,减少房颤患者栓塞事件的发生.

Objective To analyze the anticoagulation in patients with atrial fibrillation.Methods A retrospective analysis of anticoagulant therapy situation in 926 patients with atrial fibrillation was conducted,in order to sum up experience and improve the understanding of atrial fibrillation.Results In 926 patients with atrial fibrillation,there were no anticoagulant therapy in 675 patients,accounting for 72.89%,while only 251 cases received the treatment of anticoagulation,accounting for 27.11%.Only 66 patients aged〉75 years were treated with anticoagulant therapy,accounting for 33.17%.The patients with coronary heart disease,in 17.60% and with anticoagulation treatment,the patients with diabetes in 28.37% and received anticoagulation therapy,28.32% patients with anticoagulation therapy in patients with hypertension,30.77% patients with cardiac insufficiency with anticoagulant therapy.Choice of treatment of aged〉75,hypertension,coronary heart disease,clinical treatment strategies and patients were the main factors that affected the use of warfarin,but only〉75 years of age,coronary heart disease,choice of treatment factors with statistical significance of three factors（OR=7.02,12.73,4.79,all P〈0.05）.675 cases without anticoagulant therapy in 101 patients with non warfarin treatment indications without the use of warfarin anticoagulation treatment,accounted for 14.96%.In addition,there were 574 AF patients with warfarin treatment indications and treatment with warfarin,analysis of its causes：63 cases had anticoagulant contraindications,172 cases for the doctor too much about bleeding complications,440 patients were not in accordance with the requirements of the detection of INR.Conclusion The positive effect of warfarin in prevention of ischemic stroke,but in basic hospital application of warfarin anticoagulation in patients with severe AF deficiency,should raise the awareness of risk of grassroots medical staff and patients of atrial fibrillation complicating embolism,do a good job of educating patients,to reduce the incidence of embolic events in patients with atrial fibrillation.