非瓣膜性心房颤动住院患者抗凝治疗现状调查

陈林 蒲鹏

[摘要] 目的 调查县级医院非瓣膜性心房颤动住院患者抗凝治疗现状，以更好地指导心房颤动抗凝治疗。 方法 回顾性分析和统计2016年1月～2017年6月在长寿区中医院住院的非瓣膜性房颤患者的住院病历。对纳入病例应用CHA2DS2-VASc评分进行卒中风险分层和HAS-BLED评分进行出血风险分层评价规范化抗凝情况；并电话调查未抗凝治疗的原因。 结果 共186例患者纳入本研究，CHA2DS2-VASc评分≥2分有抗凝指征148例（79.6%），抗凝治疗16例（8.6%）；抗血小板治疗138例（74.2%）；卒中高危患者中未抗凝治疗的主要原因为医生因素占81.6%。 结论 县级医院非瓣膜性心房颤动患者抗凝治疗率较低，以抗血小板为主，医生因素是患者未抗凝治疗的主要原因。

[关键词] 心房颤动；抗凝治疗；抗血小板治疗；CHA2DS2-VASc；HAS-BLED

[中图分类号] R541.75 [文献标识码] B [文章编号] 1673-9701（2018）06-0131-04

[Abstract] Objective To investigate the current status of anticoagulant therapy in hospitalized patients with nonvalvular atrial fibrillation in county-level hospitals so as to better guide anticoagulation therapy of atrial fibrillation. Methods The case history of nonvalvular atrial fibrillation patients hospitalized in Changshou District Chinese Medicine Hospital from January 2016 to June 2017 was retrospectively and statistically analyzed. Stroke risk stratification was performed in the included cases using the CHA2DS2-VASc score and the bleeding risk stratification was assessed using HAS-BLED score， to evaluate normalized anticoagulation. And the cause of non-anticoagulant therapy was investigated by telephone. Results A total of 186 patients were enrolled in this study. There were 148 patients（79.6%） who had anticoagulation indications with CHA2DS2-VASc score≥2 and 16 patients（8.6%） who underwent anticoagulant therapy. There were 138 patients（74.2%） who underwent antiplatelet therapy. The main cause of non-anticoagulant therapy in high-risk stroke patients was doctor's factor（81.6%）. Conclusion The anticoagulant rate of nonvalvular atrial fibrillation in county-level hospitals is very low， with the main treatment of anti-platelet aggregation. The main cause of anticoagulant therapy is anti-platelet therapy. The doctor's factor is the main reason why patients are not treated with anti-coagulation.

[Key words] Atrial fibrillation； Anticoagulant therapy； Antiplatelet therapy； CHA2DS2-VASc； HAS-BLED

心房顫动（atrial fibrillation，AF）占心律失常住院患者的1/3，是脑卒中独立危险因素，其最常见的并发症是脑动脉栓塞[1]。非瓣膜性心房颤动（nonvalvular atrial fibrillation，NVAF）近年来发生率明显升高，年龄越大的非瓣膜性心房颤动患者发生卒中风险也越高，这类患者每年栓塞事件发生率为5%，是非心房颤动患者的2～7倍，占所有脑栓塞临床事件的15%～20%[2]。规范的抗凝治疗能明显降低房颤患者卒中事件发生率，但目前我国抗凝治疗现状并不乐观，临床实际应用与指南推荐存在较大差距。本研究回顾性分析长寿区县级医院非瓣膜性病心房颤动患者抗凝治疗现状及其未抗凝治疗医方或患方影响因素，找出抗凝治疗存在的瓶颈，提高县级医院非瓣膜性心房颤动患者抗凝治疗的水平。

1资料与方法

1.1一般资料

入选对象为2016年1月～2017年6月长寿区中医院住院患者；年龄≥40岁，临床确诊为NVAF患者。排除标准：（1）心脏血运重建或其他心脏手术3个月内；（2）超声心动证明有明确的心脏瓣膜病；（3）有房性心律失常射频消融史；（4）严重贫血或血小板重度缺乏症；（5）肝硬化晚期患者；（6）近3个月内有颅内出血及消化道出血病史；（7）有其他可逆转原因造成的心房颤动，如围手术期发作、甲亢等；（8）痴呆。