脑梗死合并房颤抗栓治疗的用药分布情况调查

Distribution of drug of patients with cerebral infarction combined with atrial fibrillation treatment

目的:对脑梗死合并房颤抗栓治疗的用药分布情况进行调查。方法:选取我院2012年1月至2015年1月间收治的249例脑梗死合并房颤患者,收集患者的人口学和临床资料,并以房颤出血评分(HASBLED评分)对患者进行出血风险评估。结果:本组249例脑梗死合并房颤患者中单独服用阿司匹林102例(40.96%),单独服用氯吡格雷49例(19.68%),合并服用阿司匹林+氯吡格雷双抗28例(11.24%),皮下注射低分子肝素7例(2.81%),服用华法林31例(12.45%),未用药32例(12.85%)。脑梗死合并房颤总抗栓治疗率87.15%(217例),明显高于未治疗率12.85%(32例),差异具有统计学意义(χ~2=274.900,P<0.05)。其中抗血小板治疗率71.89%(179例)明显高于抗凝治疗率15.26%(38例),差异具有统计学意义(χ~2=162.368,P<0.05)。根据HAS-BLED评分进行分组,157例HAS-BLED评分≥3分的患者中,抗血小板治疗121例(77.07%),抗凝治疗10例(6.37%),未用药26例(16.56%);92例HAS-BLED评分<3分的患者中,抗血小板治疗58例(63.04%),抗凝治疗28例(30.43%),未用药6例(6.52%)。HAS-BLED评分≥3分组的抗血小板治疗率和未治疗率高于HAS-BLED评分<3分组,而抗凝治疗率低于HAS-BLED评分<3分组,差异均具有统计学意义(P<0.05)。除HAS-BLED评分对抗栓治疗有较大影响外,性别、年龄、受教育程度、是否医保等因素均对抗栓治疗有一定的影响。结论:脑梗死合并房颤患者抗栓治疗中抗凝治疗的华法林用药率不足,出血风险的担忧是其主要的影响因素。而HAS-BLED评分能很好地对脑梗死合并房颤患者出血风险进行评估,从而决定其抗栓治疗的用药。

Objective： To investigate and analyze the distribution of drug use in the treatment of cerebral infarction complicated with atrial fibrillation and analyze its influencing factors. Methods： 249 cases of patients with cerebral infarction complicated with atrial fibrillation were selected from January 2012 to January 2015 in our hospital,demographic and clinical data of patients were collected,the risk of bleeding of patients was evaluated by atrial fibrillation hemorrhage score（ HAS-BLED score）. Results： 102 cases of patients with cerebral infarction and atrial fibrillation（ 40. 96%） were used aspirin alone among 249 cases of patients,49 cases of patients used clopidogrel alone（ 19. 68%）. 28 cases of patients were combined use of aspirin and clopidogrel（ 11. 24%）,7 cases of patients used low molecular heparin（ 2. 81%）,31 cases of patients used warfarin（ 12. 45%）,32 cases of patients were not used drug（ 12. 85%）. Treatment rate of patients with cerebral infarction complicated with atrial fibrillation was 87. 15%（ 217cases）,significantly higher than 12. 85% of the untreated rate（ 32 cases）,the difference had statistical significance（ χ^2= 274. 900,P〈0. 05）. Antiplatelet treatment rate（ 71. 89%,179 cases） was significantly higher than anticoagulant treatment rate（ 15. 26%,38cases）,the difference had statistical significance（ χ^2= 162. 368,P〈0. 05）. According to HAS-BLED score,they were divided into two groups. HAS-BLED scores≥3 scores group had 157 cases of patients,121 cases of which（ 77. 07%） received antiplatelet treatment,10 cases（ 6. 37%） received anticoagulation treatment,26 cases were not used drugs（ 16. 56%）; 92 cases of patients were in HAS-BLED scores 〈3 scores group,58 cases of which（ 63. 04%） received antiplatelet treatment,28 cases received anticoagulant treatment（ 30. 43%）,6 cases of were not used drugs（ 6. 52%）. Antiplatelet treatment rate and untreated rate of HAS-BLED score≥3 scores group were higher than those of HAS-BLED score 〈3 scores group,the difference had statistical significance（ P〈0. 05）. Conclusion：Warfarin drug use rate of anticoagulation treatment in treatment of anti thrombosis of patients with cerebral infarction complicated with atrial fibrillation is not enough,and the risk of bleeding is the main impact factor. While HAS-BLED score is good for bleeding risk assessment of patients with cerebral infarction and atrial fibrillation,so as to determine its antithrombotic treatment drugs.