某院就诊心房颤动患者抗凝治疗效果及影响因素分析

Analysis on the effect and influencing factors of anticoagulant therapy in patients with atrial fibrillation in a hospital

目的分析北京市大兴区人民医院就诊心房颤动患者抗凝治疗状况。方法采用回顾性分析研究法,对2021年1月至12月北京市大兴区人民医院就诊的162例心房颤动患者展开分析,随访患者的抗凝情况将其分为抗凝有效组(117例)和抗凝无效组(45例)。对两组各项资料进行比较,明确心房颤动患者抗凝治疗无效的相关因素。结果两组年龄,性别,吸烟比例,β受体阻滞剂、利尿剂、降压药物、调脂药物、硝酸酯类、止血药物应用占比,心功能不全占比、射频消融术占比、持续性房颤占比,入院心率、丙氨酸转氨酶、天冬氨酸转氨酶、凝血酶时间、凝血酶原时间、活化部分凝血活酶时间、国际标准化比值水平比较,差异有统计学意义(P<0.05)。抗凝有效组非甾体抗炎药物应用占比、肿瘤占比、血小板计数、凝血酶原活动度、纤维蛋白原、D-二聚体低于抗凝无效组;住院时间短于抗凝无效组,差异有统计学意义(P<0.05)。Logistic回归分析结果显示,年龄≥65岁(OR=6.206,95%CI=1.342~28.698)、持续性房颤(OR=1.737,95%CI=2.397~4.184)、D-二聚体<0.5 mg/L(OR=4.659,95%CI=1.590~13.649)为心房颤动患者抗凝治疗无效的影响因素(P<0.05)。结论北京市大兴区人民医院心房颤动患者抗凝率较佳,应对高龄、持续性房颤、D-二聚体水平较低的高危患者加强监测,及时调整抗凝方案,改善抗凝效果。

Objective To analyze the status of anticoagulation therapy in patients with atrial fibrillation in Daxing District People’s Hospital of Beijing.Methods Retrospective analysis was used to analyze 162 patients with atrial fibrillation in Daxing District People’s Hospital of Beijing from January to December 2021,and the anticoagulation status of follow-up patients was divided into effective anticoagulation group(117 cases)and ineffective anticoagulation group(45 cases).The data of the two groups were compared to identify the factors related to the failure of anticoagulant therapy in patients with atrial fibrillation.Results There were statistically significant differences in age,sex,smoking ratio,the proportion of users ofβ-blockers,diuretics,antihypertensive drugs,lipid-regulating drugs,nitrates,and hemostatic drugs,cardiac insufficiency ratio,radiofrequency ablation ratio,persistent atrial fibrillation ratio admission heart rate,alanine aminotransferase,aspartate aminotransferase,thrombin time,prothrombin time,activated partial thromboplastin time,and international standardized ratio level of the two groups(P<0.05).The proportion of NSAIDS,tumor proportion,platelet count,prothrombin activity,fibrinogen and D-dimer in anticoagulant effective group were lower than those in anticoagulant ineffective group;the duration of hospitalization was shorter than that of anticoagulant ineffective group,and the differences were statistically significant(P<0.05).Logistic regression analysis results showed that age≥65 years(OR=6.206,95%CI=1.342-28.698),persistent atrial fibrillation(OR=1.737,95%CI=2.397-4.184),D-dimer<0.5 mg/L(OR=4.659,95%CI=1.590-13.649)were influencing factors for the efficacy of anticoagulation therapy in patients with atrial fibrillation(P<0.05).Conclusion The anticoagulation rate of patients with atrial fibrillation in Daxing District People’s Hospital of Beijing is better.The elderly patients with persistent atrial fibrillation and high-risk patients with low D-dimer level should be monitored,and the anticoagulation program should be adjusted in time to improve the anticoagulation effect.