全院2587例住院房颤患者资料的回顾性分析

发布时间：2019-06-24 11:47

【摘要】：研究目的心房颤动是临床上最常见的心律失常之一,可使患者的卒中和心衰发生率显著增加,影响患者生存质量。本次调查以山东大学齐鲁医院为单位分析本地区房颤患者性别、年龄、房颤类型、病因及相关因素等基本流行特征的分布情况及治疗方案的选择,为房颤的预防及治疗提供参考。研究方法调查2010年1月—2015年6月山东大学齐鲁医院全院心房颤动住院患者的病历资料并进行统计,通过SPSS软件对调查结果进行分析。研究结果1.全院共入选2587例房颤患者。平均年龄65.78±13.33(18-98岁)。男女房颤患者比为1.20：1。2.病例资料的流行趋势：(1)将病例资料分为20岁,20～29岁,30～39岁,40～49岁,50～59岁,60～69岁,70～79岁,≥80岁共8个年龄组,分别统计各年龄组构成比分别为0.08%、0.73%、2.55%、8.43%、19.17%、26.48%、26.71%、15.85%,总趋势随年龄先递增后递减,而60岁以上患者占总体的一半以上；(2)2010年—2015年房颤男女比有所波动,但总体上男性患者多于女性患者;(3)老年房颤患者在2010年—2015年期间所占比例总体有下降趋势。3.房颤的类型：本次调查中阵发性房颤占43.76%,持续性房颤占24.28%,永久性房颤占31.96%。按照病因进行分类,瓣膜性房颤占19.91%,非瓣膜性房颤占75.64%,孤立性房颤占4.45%。4.房颤的病因及相关因素：分别统计以下房颤相关病因及相关因素,结果显示所占比例最高的为老年(年龄65岁)一项,占53.30%、其次为高血压及冠状动脉粥样硬化性心脏病,分别占42.67%和40.78%,其后依次为风湿性心脏病17.86%、糖尿病12.68%、心肌病4.29%、慢性阻塞性肺病4.21%、特发性4.45%、甲状腺功能亢进4.10%、先天性心脏病2.47%、肺源性心脏病1.01%。5.房颤并发缺血性脑卒中的影响因素：统计并分析房颤病人发生缺血性脑卒中与高龄(≥75岁)、糖尿病、高血压、瓣膜疾病或人工瓣膜置换术后、明显超重(BMI≥26kg/m2)、肥厚性心肌病、血脂异常(TG≥2.26mmol/L,或LDL-C≥4.14mmol/L)等影响因素的关系,结果表明高血压及高龄与房颤并发脑栓塞显著相关。6.房颤的抗栓治疗：(1)不同科室口服抗凝药的使用情况：口服抗凝药在心血管外科用药率最高,达57.26%,在心血管内科、急诊科、ICU及神经内科用药率次之；(2)抗栓治疗药物的用药情况：本组房颤病例总体上有43.18%行抗血小板治疗,24.04%行抗凝治疗(包括达比加群、利伐沙班等NOACs),6.61%行抗血小板联合抗凝治疗。抗血小板治疗在阵发性及持续性房颤患者中均占主要地位。在阵发性房颤中,抗血小板治疗、二者联合抗栓治疗均明显高于持续性房颤,而在持续性房颤中对于抗凝治疗的选择则显著升高；(3)抗栓塞药物对房颤脑卒中发生的影响：本次研究比较上述三种抗栓治疗能否显著降低房颤患者脑栓塞的发生。数据显示与未抗栓组相比,抗凝治疗、二者联合抗栓治疗均可显著降低房颤患者脑栓塞的发生,单行抗血小板治疗与未行抗血栓治疗患者相比不能显著减少房颤患者脑栓塞的发生。与抗凝治疗组相比,联合抗栓治疗在减少房颤患者脑栓塞发生方面的差异并无显著性。7.房颤的心率控制及节律控制治疗：总体来说,心室率控制占据主要地位,约占所有房颤患者的52.18%,药物转复和维持窦律者占19.40%,电复率者占0.23%,行射频消融术者占11.71%。(1)阵发性房颤：采用心室率控制者占56.89%,主要的心室率控制药物为6受体阻滞剂,采用药物转复和维持窦性心律者占27.83%,主要的节律控制药物为胺碘酮,行电复律者占0.35%,行射频消融术者占14.31%。(2)持续性房颤：行心室率控制者占48.18%,药物转复和维持窦性心律者占12.71%,行电复律者占0.14%,行射频消融术者占9.71%。(3)房颤类型对治疗方案选择的影响：分析房颤类型对控制心室率、药物转复和维持窦律、射频消融三种治疗手段的影响,结果显示控制心室率、药物转复和维持窦律、射频消融三种治疗手段在不同房颤类型中的差异均具有显著性。阵发性房颤无论是在心率控制还是节律控制方面的治疗率均明显高于持续性房颤。研究结论1.我院房颤的基本流行病学趋势与国内外报道相似,即平均年龄较高,男性患者多于女性患者,且随着年龄的增高房颤患者比例随之增加,房颤发生的相关因素中老年、高血压、糖尿病占据主要地位。但本次研究发现老年住院患者的总体比例有逐年下降的特点,可能在一定程度上反映心血管疾病的年轻化趋势。2.对房颤病人缺血性脑卒中的防治方面存在抗栓治疗不足,抗栓药物,尤其是口服抗凝药的用药率低下,尚未达到预防缺血性脑卒中的理想水平。3.本次调查发现,相比房颤患者的节律控制,其采用心室率控制的水平较高。而导管消融在房颤总体治疗策略中的地位得到提升。
[Abstract]:The study of atrial fibrillation is one of the most common arrhythmias in the clinic, which can increase the incidence of stroke and heart failure in the patients, and affect the quality of life of the patients. This survey is based on Qilu Hospital of Shandong University to analyze the distribution of the basic epidemic characteristics such as sex, age, type of atrial fibrillation, cause and related factors of AF in the region, and provide reference for the prevention and treatment of atrial fibrillation. The medical records of the patients with atrial fibrillation in the whole hospital of Qilu Hospital of Shandong University in January 2010 to June 2015 were investigated and the results were analyzed by SPSS software. Study Results 1. A total of 2587 patients with atrial fibrillation were enrolled in the whole hospital. The mean age was 65.78-13.33 (18-98 years). The ratio of patients with atrial fibrillation was 1.20: 1.2. The prevalence of case data: (1) The case data was divided into 20 years,20 to 29 years old,30 to 39 years old,40 to 49 years old,50 to 59 years old,60 to 69 years old,70 to 79 years old and 80 years of age. The proportion of each age group was 0.08%, 0.73%, 2.55%, 8.43%, 19.17%, 26.48%, 26.71% and 15.85%, respectively. The overall trend decreased with age, while more than half of the total was over 60 years of age; (2) the ratio of men and women in the period of 2010 to 2015 was fluctuating, but more in the overall male than in women; and (3) the overall decline in the proportion of elderly patients with atrial fibrillation during the period 2010-2015. The type of atrial fibrillation: in this survey, paroxysmal atrial fibrillation accounted for 43.76%, persistent AF was 24.28%, and permanent atrial fibrillation accounted for 31.96%. According to the etiology, the valvular atrial fibrillation accounted for 19.91%, the non-valvular atrial fibrillation accounted for 75.64%, and the isolated AF accounted for 4.45%. The etiology and related factors of atrial fibrillation: the etiology and related factors of the following atrial fibrillation: the highest proportion of the elderly (age 65), 53.30%, followed by high blood pressure and coronary heart disease (42.67% and 40.78%, respectively). It was followed by 17.86% of rheumatic heart disease, 12.68% of diabetes, 4.29% of cardiomyopathy, 4.21% of chronic obstructive pulmonary disease, 4.45% of idiopathic hyperthyroid, 4.10% of hyperthyroidism, 2.47% of congenital heart disease and 1.01% of pulmonary heart disease. The influencing factors of AF complicated with ischemic stroke were: statistics and analysis of the incidence of ischemic stroke in patients with atrial fibrillation compared with the old age (75 years of age), diabetes, hypertension, valve disease or artificial valve replacement, significantly overweight (26 kg/ m2 of BMI), hypertrophic cardiomyopathy, and dyslipidemia (TG-2.26 mmol/ L, Or LDL-C (4.14 mmol/ L). Antithrombotic therapy for atrial fibrillation: (1) The use of oral anticoagulants in different departments: the highest rate of oral anticoagulants in the cardiovascular surgery is 57.26%, the second is in the cardiovascular department of medicine, the emergency department, the ICU and the neurology department; and (2) the medication of the anti-thrombotic agent: In this group, there were 43.18% anti-platelet therapy, 24.04% anti-coagulation therapy (including NOACs of dabigatran, rivaroxaban, etc.), and 6.61% of anti-platelet and anti-platelet therapy. Antiplatelet therapy is dominant in patients with paroxysmal and persistent AF. In the treatment of paroxysmal atrial fibrillation, anti-platelet therapy, both of which were significantly higher than persistent AF, significantly increased in the selection of anticoagulant therapy in persistent AF; and (3) the effect of anti-embolic drugs on the onset of atrial fibrillation: The study compared the above three anti-thrombotic therapy to significantly reduce the cerebral embolism in patients with atrial fibrillation. The data show that the anti-platelet therapy can significantly reduce the occurrence of cerebral embolism in the patients with atrial fibrillation compared with the non-antithrombotic group, and the single-line anti-platelet therapy does not significantly reduce the occurrence of cerebral embolism in the patients with atrial fibrillation compared with the patients without anti-thrombotic therapy. The difference in the incidence of cerebral embolism in patients with AF was not significant compared with the anticoagulant therapy group. The control of heart rate and rhythm control of atrial fibrillation: In general, ventricular rate control was dominant, accounting for 52.18% of all patients with atrial fibrillation, 19.40% for drug transfer and maintenance, 0.23% for electric complex, and 11.71% for radiofrequency ablation. (1) Paroxysmal atrial fibrillation: 56.89% of ventricular rate control was used, the main ventricular rate control drug was 6 receptor blocker, 27.83% of the main rhythm control drug was used, the main rhythm control drug was amiodarone, and the electric cardioverter was 0.35%. The frequency of radiofrequency ablation was 14.31%. (2) Persistent atrial fibrillation: 48.18% of the patients with ventricular rate control, 12.71% of the patients with drug transfer and maintenance, 0.14% for electric cardioverter and 9.71% for radiofrequency ablation. (3) The effect of the type of AF on the choice of treatment options: the effect of the type of AF on the control of ventricular rate, drug transfer and maintenance, and radiofrequency ablation, and the results showed that the control of ventricular rate, drug transfer and maintenance of atrial fibrillation were controlled. The difference of three methods of RF ablation in different types of AF was significant. Paroxysmal atrial fibrillation is significantly higher in both heart rate control and rhythm control than in persistent AF. Study Conclusion 1. The basic epidemiological trend of atrial fibrillation in our hospital is similar to that of both home and abroad, that is, the average age is higher, the number of male patients is more than that of female patients, and the proportion of patients with atrial fibrillation increases with age. However, this study has found that the overall proportion of the elderly in the elderly is decreasing year by year, which may reflect the young trend of the cardiovascular disease to a certain extent. The prevention and treatment of ischemic stroke in patients with atrial fibrillation is not enough, and the anti-thrombus drug, especially the oral anticoagulant, has not reached the ideal level for the prevention of ischemic stroke. The study found that the rate of ventricular rate control was higher compared to the rhythm control in patients with atrial fibrillation. The status of catheter ablation in the overall treatment strategy for atrial fibrillation is improved.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R541.75

【相似文献】