社区老年房颤患者临床特征研究

发布时间：2018-02-14 14:35

  本文关键词： 房颤 社区研究 抗凝治疗　出处：《川北医学院》2017年硕士论文　论文类型：学位论文

【摘要】：研究目的:分析社区老年人群心房颤动(房颤)患者房颤类型、相关疾病、血栓栓塞危险评分情况以及抗血栓治疗现状,为社区房颤患者的管理提供指导。方法:2013年4月~10月,对上海市金山区11个社区65岁以上老年人共30643人以整群抽样调查设计进行健康体检,对筛查出的1801(5.9%)例房颤患者进行横断面调查。由研究者填写“心房颤动现况调查表”,调查内容包括社会人口学情况、一般健康状况、现病史、既往史、基础疾病以及以房颤临床特征为主要内容的问卷调查。共收集1416份有效问卷例。根据2015年中华医学会心电生理和起搏分会房颤卒中风险评估系统评分标准对患者进行CHADS2评分、CHA2DS2-VASc评分与HAS-BLED出血风险评分;分析患者接受抗血栓治疗情况。结果:1.社区老年房颤男女比例为0.98:1,平均年龄76.1±6.4岁。总患病率5.9%(1801/30643),男性病人房颤患病率高于女性(6.8%:5.1%,P=0.000)。2.房颤病人中,有吸烟史者16.4%、饮酒史者13.7%和家族史者4.4%。3.所有房颤病人中,首诊房颤、阵发性房颤、持续性房颤、永久性房颤所占比例分别为60.4%、18.6%、8.3%、12.8%。4.房颤病人最常见的合并症依次为高血压59.7%、冠心病35.4%、糖尿病9.5%、病窦综合征2.5%、左心室肥厚2.2%、心力衰竭1.8%、甲亢0.8%、心肌病0.4%和风湿性心脏病0.1%。5.CHADS2评分≥2分房颤患者共592(41.8%)例,仅4.7%接受抗凝治疗,27.7%接受抗血小板治疗。CHADS2评分=1分房颤患者共604(42.7%)例,5.3%接受抗凝治疗,18.5%接受抗血小板治疗。CHADS2评分=0分房颤患者共220(15.5%)例,6.4%接受抗凝治疗,20.0%接受抗血小板治疗。CHA2DS2-VASc评分≥2分房颤患者共1293(91.3%)例,仅5.2%接受抗凝治疗,22.9%接受抗血小板治疗。CHA2DS2-VASc评分为1分者共123(8.7%)例,5.7%采用了抗凝治疗,19.5%采用了抗血小板治疗。结论:社区老年房颤患者人群中,首诊房颤患者所占比例较大,血栓栓塞危险评分≥2分者所占比例大,但接受抗血栓治疗比例低。
[Abstract]:Objective: to analyze the types of atrial fibrillation (AF), related diseases, risk score of thromboembolism and current status of antithrombotic therapy in elderly patients with atrial fibrillation (AF) in community. Methods: from April 2013 to October, the management of patients with atrial fibrillation in the community was studied. A total of 30643 people aged over 65 years old in 11 communities in Jinshan District of Shanghai were examined by cluster sampling design. A cross-sectional survey was carried out on the selected 1801 / 5. 9 patients with atrial fibrillation. The questionnaire was filled out by the researcher. The survey included social demographics, general health status, current medical history, and past history. Basic diseases and clinical features of atrial fibrillation. A total of 1416 valid questionnaire cases were collected. The patients were assessed according to the 2015 Chinese Medical Association ECG and pacing Branch risk Assessment criteria for Atrial Fibrillation Stroke. CHADS2 score, CHA2DS2-VASc score and HAS-BLED bleeding risk score were performed. Results: the ratio of male to female was 0.98: 1 with an average age of 76.1 卤6.4 years. The total prevalence rate of atrial fibrillation in male patients was higher than that in women, and the prevalence rate of atrial fibrillation in male patients was higher than that in female patients. 16.4 had a history of smoking, 13.7% had a history of drinking, and 4.4 had a family history. Among all patients with atrial fibrillation, the first diagnosis was atrial fibrillation, paroxysmal atrial fibrillation, persistent atrial fibrillation. The proportions of permanent atrial fibrillation were 60.4 and 18.60.3and 12.80.The most common complications in patients with atrial fibrillation were hypertension 59.7, coronary heart disease 35.4g, diabetes 9.5, sinus syndrome 2.5g, left ventricular hypertrophy 2.2, heart failure 1.8b, hyperthyroidism 0.880, cardiomyopathy 0.4% and rheumatic heart disease 0.4%. The total number of patients with atrial fibrillation 鈮，

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