陈林 蒲鹏
[摘要] 意图 查询县级医院非瓣膜性心房颤动住院患者抗凝医治现状，以更好地辅导心房颤动抗凝医治。 办法 回忆性剖析和计算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。对归入病例使用CHA2DS2-VASc评分进行卒中危险分层和HAS-BLED评分进行出血危险分层点评规范化抗凝状况；并电话查询未抗凝医治的原因。 成果 共186例患者归入本研讨，CHA2DS2-VASc评分≥2分有抗凝指征148例（79.6%），抗凝医治16例（8.6%）；抗血小板医治138例（74.2%）；卒中高危患者中未抗凝医治的主要原因为医师要素占81.6%。 定论 县级医院非瓣膜性心房颤动患者抗凝医治率较低，以抗血小板为主，医师要素是患者未抗凝医治的主要原因。
[关键词] 心房颤动；抗凝医治；抗血小板医治；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，是脑卒中独立危险要素，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）近年来发生率显着升高，年纪越大的非瓣膜性心房颤动患者发生卒中危险也越高，这类患者每年栓塞事情发生率为5%，对错心房颤动患者的2～7倍，占一切脑栓塞临床事情的15%～20%[2]。规范的抗凝医治能显着下降房颤患者卒中事情发生率，但目前我国抗凝医治现状并不达观，临床实践使用与攻略引荐存在较大距离。本研讨回忆性剖析长寿区县级医院非瓣膜性病心房颤动患者抗凝医治现状及其未抗凝医治医方或患方影响要素，找出抗凝医治存在的瓶颈，进步县级医院非瓣膜性心房颤动患者抗凝医治的水平。
1材料与办法
1.1一般材料
当选目标为2016年1月～2017年6月长寿区中医院住院患者；年纪≥40岁，临床确诊为NVAF患者。扫除规范：（1）心脏血运重建或其他心脏手术3个月内；（2）超声心动证明有清晰的心脏瓣膜病；（3）有房性心律失常射频融化史；（4）严峻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）有其他可反转原因形成的心房颤动，如围手术期发生、甲亢等；（8）发呆。
