不同级别医院心房颤动/心房扑动急诊处理用药分析

Analysis on medications used in emergency treatment for atrial fibrillation/atrial flutter in different grade of hospitals

目的:调查各级别医院心房颤动(房颤)/心房扑动(房扑)急诊处理中的用药情况。方法:2016年1月—2019年12月共选取全国东北、华北、华东、华中等地区9家不同级别医院因房颤/房扑就诊的患者。采集人口统计学指标及药物治疗情况:抗心律失常药物、抗凝药物应用等情况。结果:共入选房颤/房扑399例,其急诊处理时各级别医院使用最多的抗心律失常药物为胺碘酮(64.1%),其中三级医院及二级医院高于心血管专科医院(69.2%∶41.3%,65.9%∶41.3%,P<0.05)。各级别医院具有抗凝指征的非瓣膜房颤/房扑患者中启动长期口服抗凝药的患者占比均偏低,且三级医院及二级医院均低于心血管专科医院(22.2%:41.3%,17.9%:41.3%,P<0.05)。华法林为各级医院中应用最多的口服抗凝药物。结论:房颤/房扑急诊处理时的抗心律失常药物应用相对单一;各级别医院非瓣膜性房颤/房扑患者长期口服抗凝药物治疗比例仍低,三级医院及二级医院更为显著。房颤/房扑的急诊规范化治疗任务仍艰巨。

Objective: To investigate the medications used in emergency treatment for atrial fibrillation/atrial flutter in different grade of hospitals. Methods: Patients admitted to hospitals for atrial fibrillation/atrial flutter from January 2016 to December 2019 were enrolled. A total of 9 hospitals in Northeast, Eastern, North and Central China participated in the study. The demographic data and drug treatment application of antiarrhythmic drugs(AADs) and anticoagulants administration were observed. Results: A total of 399 cases of atrial fibrillation/atrial flutter were assessed. Amiodarone(64.1%) was the most commonly used AADs during emergency treatment of atrial fibrillation/atrial flutter, and the proportion of it was significantly higher in tertiary and secondary hospitals than the cardiovascular specialist hospitals(69.2% vs 41.3%, 65.9% vs 41.3%, P <0.05, respectively). The percentage of patients in non-valvular atrial fibrillation/atrial flutter(NVAF) with anticoagulant indications had started long-term oral anticoagulants was low in all grade of hospitals, and it was significantly lower in tertiary and secondary hospitals than the cardiovascular specialist hospitals(22.2% vs 41.3%, 17.9% vs 41.3%, P <0.05, respectively), Warfarin was the most commonly used oral anticoagulant in all grade of hospitals. Conclusion: The drugs used in the emergency treatment of atrial fibrillation/atrial flutter in different grade of hospitals were simplex relatively;the proportion of anticoagulant therapy in NVAF was still low at all grade of hospitals, which were significantly lower in tertiary and secondary hospitals.