| 陈瑾瑾,刘培延,张倩,等.200例非瓣膜性心房颤动住院病人抗凝治疗现状及影响因素分析[J].安徽医药,2019,23(2):406-410. |
| 200例非瓣膜性心房颤动住院病人抗凝治疗现状及影响因素分析 |
| Analysis of current application status and influencing factors of anticoagulation therapy in 200 patients with non-valvalar atrial fibrillation |
| 投稿时间：2017-07-02 |
| DOI： |
| 中文关键词: 非瓣膜性心房颤动 抗凝 卒中 出血 |
| 英文关键词: Non-valvular atrial fibrillation Anticoagulation Thromboembolism Bleeding |
| 基金项目:南京市科技计划项目(201605026) ◇医院药学◇200例非瓣膜性心房颤动住院病人抗凝治疗现状及影响因素分析陈瑾瑾,刘培延,张倩,朱建成(南京医科大学附属南京医院(南京市第一医院)药学部,江苏 南京 210006) |
|
| 摘要点击次数: 1905 |
| 全文下载次数: 466 |
| 中文摘要: |
| 目的 了解非瓣膜性心房颤动(NVAF)住院病人抗凝治疗的现状并探讨其影响因素。方法 回顾性分析2017年1—5月南京医科大学附属南京医院200例NVAF住院病人的临床特征及抗凝治疗方案,应用CHA2DS2-VASc和HAS-BLED评分对卒中风险和出血风险进行评估；根据危险分层分析抗凝药物的临床应用情况；并运用logistic回归分析讨论抗栓治疗的影响因素。结果 入选病人CHA2DS2-VASc评分平均(4.55±2.01)分,卒中高危组189例(94.5%),卒中中危组11例(5.5%)；HAS-BLED评分平均(2.04±1.26)分,高出血风险组69例(34.5%),低出血风险组131例(65.5%)。仅36.0%病人接受抗凝治疗,抗凝治疗率随卒中风险的增加呈先升后降的趋势,卒中高危组抗凝治疗率(36.5%)高于卒中中危组(27.3%),差异无统计学意义(χ2=1.305,P=0.521)；抗凝治疗率随着出血评分的增加而降低,低出血风险组的抗凝治疗率(44.3%)高于高出血风险组(20.3%),且差异有统计学意义(χ2=11.350,P=0.003)。抗凝亚组中,高出血风险组较低出血风险组倾向于选择新型口服抗凝药(P=0.031)。logistic回归分析表明合并血管疾病(OR=0.867)、药物(OR=2.182)、PCI术后(OR=3.557)、房颤消融术后(OR=0.255)及病人因素(OR=4.504)均影响抗凝方案的选择,且PCI术后和病人因素的影响差异有统计学意义(P＜0.05)。结论 目前南京医科大学附属南京医院对NVAF的抗凝治疗与指南推荐有一定的差距,未按危险分层标准抗凝且整体的抗凝治疗率低。 |
| 英文摘要: |
| Objective To investigate the utilization of anticoagulation therapy and related factors in hospitalized patients with non-valvular atrial fibrillation (NVAF).Methods The clinical data and anticoagulation therapy of 200 patients with NVAF in Nanjing First Hospital Affiliated to Nanjing Medical University from January 2017 to May 2017 were retrospectively analyzed.The stroke and bleeding risk of patients were evaluated by CHA2DS2-VASc score and HAS-BLED score.Application of anticoagulant was observed according to the stroke and bleeding risk,and the related factors which influence the decision of anticoagulation therapy were analyzed using logistic regression analysis.Results The mean CHA2DS2-VASc score of enrolled patients with NVAF was (4.55±2.01),and 189 cases (94.5%) were defined as high stroke risk,11 cases (5.5%) as intermediate stroke risk; the mean HAS-BLED score was 2.04±1.26,69 cases (34.5%) as high bleeding risk,131 cases (65.5%) as low bleeding risk.Only 36 percent of patients were treated with anticoagulant; the rate of treatment tends to first rise then descend with the increase in stroke risk.The rate of anticoagulant therapy in high stroke risk group was higher than that in intermediate stroke risk group with no significant difference (36.5% vs. 27.3%,χ2=1.305,P=0.521).The rate of anticoagulant therapy decreased with the increase in bleeding score.The treatment rate of low bleeding risk group was higher than that of high bleeding risk group with significant difference (44.3% vs. 20.3%,χ2=11.350,P=0.003).In coagulation subgroups,high bleeding risk group tended to choose new type of oral anticoagulant in comparison with low bleeding risk group (P=0.031).A logistic regression analysis showed that combined vascular disease (OR=0.867),drugs concomitantly (OR=2.182),after percutaneous coronary intervention (PCI) (OR=3.557),after atrial fibrillation ablation (OR=0.255) and patients' factors (OR=4.504) were the main factors influencing anticoagulant therapy,and the factor of after PCI and patients' factors had statistical difference (P＜0.05).Conclusions There is an obvious gap between the present situation and the guideline for anticoagulation therapy in most of these patients with NVAF.Anticoagulation has not been carried out according to stratified risk criteria in these patients and the overall rate of anticoagulation therapy is low. |
|
查看全文
查看/发表评论 下载PDF阅读器 |
| 关闭 |
|
|
|
