院外急救与心房颤动患者心脑血管事件的相关性研究

Correlation between pre-hospital emergency treatment and cardiocerebral vascular events in patients with atrial fibrillation

目的胺碘酮广泛应用于快速心房颤动的药物治疗，但目前临床上院外急救与心房颤动患者心脑血管事件的随访资料较少，本研究探讨院外急救对心房颤动患者心脑血管事件的影响。方法入选2016年1月-2017年12月北京急救中心急诊转运的快速心房颤动患者196例心房颤动患者为研究对象，年龄（56．3±16．5）岁。入组患者均通过急诊心电图确诊，在30min内送至最近医院，根据接诊后治疗措施不同分为快速给药组，138例和延迟给药组58例，急诊救治措施主要为静脉注射抗心律失常药物胺碘酮。随访住院期间主要心脑血管不良事件（包括全因死亡事件、血栓栓塞事件和出血事件）的发生情况，采用Cox风险回归模型评估院外急救措施与心脑血管事件的关系。结果心房颤动患者住院期间心脑血管事件发生率为21．9％。延迟给药患者血栓栓塞事件发生率为19．0％，显著高于立即给药组（8．7％，P〈0．001）；延迟给药患者全因死亡事件发生率6．9％，显著高于立即给药组（3．6％，P=0．012）。Cox风险回归方程提示院外急救时间是快速心房颤动患者发生心脑血管事件的独立风险因素（风险比，HR=2．44，95％可信区间，CI=1．06—4．67，P=0．015）。结论心房颤动患者延迟给药发生心脑血管不良事件的风险明显增加，院外急救时间是快速心房颤动患者发生心脑血管事件的独立风险因素。

Objective To investigate the correlation between the timing of pre-hospital emergency treatment and cardiac-cerebral vascular events in patients with atrial fibrillation （AF）. Methods 196 consecutive patients with AF, aged （56.3±16.5） （28-95） years, were sent to hospital by emergency service system in thirty minutes. In the ambulance on the way to the nearest hospital amiodarone, an antiarrbythlnic drug effective in AF, was given at a dosage of 150 mg by intravenous injection and then intravenous drip at the speed of 1 mg/min was added if cardioversion to sinus rhythm failed. 138 patients received such treatment within thirty minutes after the medical personnel arrived （immediate administration group）, and 58 patients received the treatment after they were admitted to the hospital （delayed administation group）. All patients were followed up at hospital for the major adverse cardiocerebral vascular eveuts： all-cause death events, thromboembolism events, and bleeding events. Cox hazard proportional model was used to estimate the relationship between pre-hospital emergency treatment and cardiocerebral vascular events. Results The general incidence of cardiocerebral vascular events was 21.9%. The all-cause death event rate of the delayed administration group was 6.9%, significantly higher than that of the immediate administration group （3.6%, P=0.012）. The thromboembolism event rate of the delayed administration group was 19.0%, siguifieantly higher than that of the immediate administratiou group （8.7% ,P〈0.001）. Cox hazard proportional model analysis demonstrated that pre-hospital emergency treatment was an independently risk factor for cardio-cerebral vascular events （hazard ratio= 2.44, 95% eoufidential interval, CI=1.06-4.67, P=0.015）. Conclusion The risk of adverse eardio-cerebral vascular events is higher for the patients with AF receiving delayed antian＇hythmie drug treatment in comparison with those treated immediately. Tinting of pre-hospital emergency treatment is an independently risk factor for eardioeerebral vascular events in AF patients.