非瓣膜病心房颤动缺血性卒中的预防研究进展

Progress on prevention of nonvalvular atrial fibrillation ischemic stroke

非瓣膜病心房颤动缺血性卒中及体动脉栓塞的发病率很高,预防这一事件的发生现已成为国内外研究的热题。抗凝治疗无疑是卒中预防中重要环节之一,新型口服抗凝剂相较华法林可能对亚洲心房颤动人群血栓栓塞的预防效果更好,不良事件发生率更低,正在成为一种全新的选择。随着左心耳封堵技术日渐成熟,给不适合抗凝治疗的心房颤动患者带来了福音。射频消融不仅可以恢复窦性心律,还可以降低心房颤动负荷,减少血栓栓塞事件的发生,对于栓塞风险较高的患者来说,新型口服抗凝药联合射频消融对卒中预防效果可能会更好。肥胖、吸烟、嗜酒、高血压、糖尿病等危险因素在心房颤动病程进展中扮演了重要角色,包括心房颤动危险因素在内的综合管理对缺血性脑卒中的预防效果更佳。本文就非瓣膜病心房颤动缺血性卒中的研究进展作一综述。

The incidence of ischemic stroke and systemic arterial embolism in patients with non-valvular atrial fibrillation is very high,and the prevention of this event has become a hot topic of research at home and abroad.Anticoagulant therapy is undoubtedly one of the important links in stroke prevention.Compared with warfarin,the new oral anticoagulant may be more effective in preventing thromboembolism and lower incidence of adverse events in Asian patients with atrial fibrillation,so it is becoming a new choice.With the increasing maturity of left atrial appendage occlusion technology,it brings good news to patients with atrial fibrillation who are not suitable for anticoagulation therapy.Radiofrequency ablation can not only restore sinus rhythm,but also reduce the load of atrial fibrillation and reduce the occurrence of thromboembolic events.for patients with high risk of embolism,new oral anticoagulants combined with radiofrequency ablation may be more effective in stroke prevention.Obesity,smoking,alcohol addiction,hypertension,diabetes and other risk factors play an important role in the progression of atrial fibrillation.Comprehensive management,including risk factors of atrial fibrillation,is more effective in the prevention of ischemic stroke.This article reviews the research progress of ischemic stroke in non-valvular atrial fibrillation.