陳林 蒲鵬

[摘要] 目的 調(diào)查縣級醫(yī)院非瓣膜性心房顫動住院患者抗凝治療現(xiàn)狀，以更好地指導(dǎo)心房顫動抗凝治療。 方法 回顧性分析和統(tǒng)計2016年1月～2017年6月在長壽區(qū)中醫(yī)院住院的非瓣膜性房顫患者的住院病歷。對納入病例應(yīng)用CHA2DS2-VASc評分進(jìn)行卒中風(fēng)險分層和HAS-BLED評分進(jìn)行出血風(fēng)險分層評價規(guī)范化抗凝情況；并電話調(diào)查未抗凝治療的原因。 結(jié)果 共186例患者納入本研究，CHA2DS2-VASc評分≥2分有抗凝指征148例（79.6%），抗凝治療16例（8.6%）；抗血小板治療138例（74.2%）；卒中高?；颊咧形纯鼓委煹闹饕驗獒t(yī)生因素占81.6%。 結(jié)論 縣級醫(yī)院非瓣膜性心房顫動患者抗凝治療率較低，以抗血小板為主，醫(yī)生因素是患者未抗凝治療的主要原因。

[關(guān)鍵詞] 心房顫動；抗凝治療；抗血小板治療；CHA2DS2-VASc；HAS-BLED

[中圖分類號] R541.75 [文獻(xiàn)標(biāo)識碼] B [文章編號] 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

心房顫動（atrial fibrillation，AF）占心律失常住院患者的1/3，是腦卒中獨(dú)立危險因素，其最常見的并發(fā)癥是腦動脈栓塞[1]。非瓣膜性心房顫動（nonvalvular atrial fibrillation，NVAF）近年來發(fā)生率明顯升高，年齡越大的非瓣膜性心房顫動患者發(fā)生卒中風(fēng)險也越高，這類患者每年栓塞事件發(fā)生率為5%，是非心房顫動患者的2～7倍，占所有腦栓塞臨床事件的15%～20%[2]。規(guī)范的抗凝治療能明顯降低房顫患者卒中事件發(fā)生率，但目前我國抗凝治療現(xiàn)狀并不樂觀，臨床實(shí)際應(yīng)用與指南推薦存在較大差距。本研究回顧性分析長壽區(qū)縣級醫(yī)院非瓣膜性病心房顫動患者抗凝治療現(xiàn)狀及其未抗凝治療醫(yī)方或患方影響因素，找出抗凝治療存在的瓶頸，提高縣級醫(yī)院非瓣膜性心房顫動患者抗凝治療的水平。

1資料與方法

1.1一般資料

入選對象為2016年1月～2017年6月長壽區(qū)中醫(yī)院住院患者；年齡≥40歲，臨床確診為NVAF患者。排除標(biāo)準(zhǔn)：（1）心臟血運(yùn)重建或其他心臟手術(shù)3個月內(nèi)；（2）超聲心動證明有明確的心臟瓣膜病；（3）有房性心律失常射頻消融史；（4）嚴(yán)重貧血或血小板重度缺乏癥；（5）肝硬化晚期患者；（6）近3個月內(nèi)有顱內(nèi)出血及消化道出血病史；（7）有其他可逆轉(zhuǎn)原因造成的心房顫動，如圍手術(shù)期發(fā)作、甲亢等；（8）癡呆。