【摘要】：研究目的心房顫動(dòng)是臨床上最常見的心律失常之一,可使患者的卒中和心衰發(fā)生率顯著增加,影響患者生存質(zhì)量。本次調(diào)查以山東大學(xué)齊魯醫(yī)院為單位分析本地區(qū)房顫患者性別、年齡、房顫類型、病因及相關(guān)因素等基本流行特征的分布情況及治療方案的選擇,為房顫的預(yù)防及治療提供參考。研究方法調(diào)查2010年1月—2015年6月山東大學(xué)齊魯醫(yī)院全院心房顫動(dòng)住院患者的病歷資料并進(jìn)行統(tǒng)計(jì),通過SPSS軟件對(duì)調(diào)查結(jié)果進(jìn)行分析。研究結(jié)果1.全院共入選2587例房顫患者。平均年齡65.78±13.33(18-98歲)。男女房顫患者比為1.20：1。2.病例資料的流行趨勢：(1)將病例資料分為20歲,20～29歲,30～39歲,40～49歲,50～59歲,60～69歲,70～79歲,≥80歲共8個(gè)年齡組,分別統(tǒng)計(jì)各年齡組構(gòu)成比分別為0.08%、0.73%、2.55%、8.43%、19.17%、26.48%、26.71%、15.85%,總趨勢隨年齡先遞增后遞減,而60歲以上患者占總體的一半以上；(2)2010年—2015年房顫男女比有所波動(dòng),但總體上男性患者多于女性患者;(3)老年房顫患者在2010年—2015年期間所占比例總體有下降趨勢。3.房顫的類型：本次調(diào)查中陣發(fā)性房顫占43.76%,持續(xù)性房顫占24.28%,永久性房顫占31.96%。按照病因進(jìn)行分類,瓣膜性房顫占19.91%,非瓣膜性房顫占75.64%,孤立性房顫占4.45%。4.房顫的病因及相關(guān)因素：分別統(tǒng)計(jì)以下房顫相關(guān)病因及相關(guān)因素,結(jié)果顯示所占比例最高的為老年(年齡65歲)一項(xiàng),占53.30%、其次為高血壓及冠狀動(dòng)脈粥樣硬化性心臟病,分別占42.67%和40.78%,其后依次為風(fēng)濕性心臟病17.86%、糖尿病12.68%、心肌病4.29%、慢性阻塞性肺病4.21%、特發(fā)性4.45%、甲狀腺功能亢進(jìn)4.10%、先天性心臟病2.47%、肺源性心臟病1.01%。5.房顫并發(fā)缺血性腦卒中的影響因素：統(tǒng)計(jì)并分析房顫病人發(fā)生缺血性腦卒中與高齡(≥75歲)、糖尿病、高血壓、瓣膜疾病或人工瓣膜置換術(shù)后、明顯超重(BMI≥26kg/m2)、肥厚性心肌病、血脂異常(TG≥2.26mmol/L,或LDL-C≥4.14mmol/L)等影響因素的關(guān)系,結(jié)果表明高血壓及高齡與房顫并發(fā)腦栓塞顯著相關(guān)。6.房顫的抗栓治療：(1)不同科室口服抗凝藥的使用情況：口服抗凝藥在心血管外科用藥率最高,達(dá)57.26%,在心血管內(nèi)科、急診科、ICU及神經(jīng)內(nèi)科用藥率次之；(2)抗栓治療藥物的用藥情況：本組房顫病例總體上有43.18%行抗血小板治療,24.04%行抗凝治療(包括達(dá)比加群、利伐沙班等NOACs),6.61%行抗血小板聯(lián)合抗凝治療�？寡“逯委熢陉嚢l(fā)性及持續(xù)性房顫患者中均占主要地位。在陣發(fā)性房顫中,抗血小板治療、二者聯(lián)合抗栓治療均明顯高于持續(xù)性房顫,而在持續(xù)性房顫中對(duì)于抗凝治療的選擇則顯著升高；(3)抗栓塞藥物對(duì)房顫腦卒中發(fā)生的影響：本次研究比較上述三種抗栓治療能否顯著降低房顫患者腦栓塞的發(fā)生。數(shù)據(jù)顯示與未抗栓組相比,抗凝治療、二者聯(lián)合抗栓治療均可顯著降低房顫患者腦栓塞的發(fā)生,單行抗血小板治療與未行抗血栓治療患者相比不能顯著減少房顫患者腦栓塞的發(fā)生。與抗凝治療組相比,聯(lián)合抗栓治療在減少房顫患者腦栓塞發(fā)生方面的差異并無顯著性。7.房顫的心率控制及節(jié)律控制治療：總體來說,心室率控制占據(jù)主要地位,約占所有房顫患者的52.18%,藥物轉(zhuǎn)復(fù)和維持竇律者占19.40%,電復(fù)率者占0.23%,行射頻消融術(shù)者占11.71%。(1)陣發(fā)性房顫：采用心室率控制者占56.89%,主要的心室率控制藥物為6受體阻滯劑,采用藥物轉(zhuǎn)復(fù)和維持竇性心律者占27.83%,主要的節(jié)律控制藥物為胺碘酮,行電復(fù)律者占0.35%,行射頻消融術(shù)者占14.31%。(2)持續(xù)性房顫：行心室率控制者占48.18%,藥物轉(zhuǎn)復(fù)和維持竇性心律者占12.71%,行電復(fù)律者占0.14%,行射頻消融術(shù)者占9.71%。(3)房顫類型對(duì)治療方案選擇的影響：分析房顫類型對(duì)控制心室率、藥物轉(zhuǎn)復(fù)和維持竇律、射頻消融三種治療手段的影響,結(jié)果顯示控制心室率、藥物轉(zhuǎn)復(fù)和維持竇律、射頻消融三種治療手段在不同房顫類型中的差異均具有顯著性。陣發(fā)性房顫無論是在心率控制還是節(jié)律控制方面的治療率均明顯高于持續(xù)性房顫。研究結(jié)論1.我院房顫的基本流行病學(xué)趨勢與國內(nèi)外報(bào)道相似,即平均年齡較高,男性患者多于女性患者,且隨著年齡的增高房顫患者比例隨之增加,房顫發(fā)生的相關(guān)因素中老年、高血壓、糖尿病占據(jù)主要地位。但本次研究發(fā)現(xiàn)老年住院患者的總體比例有逐年下降的特點(diǎn),可能在一定程度上反映心血管疾病的年輕化趨勢。2.對(duì)房顫病人缺血性腦卒中的防治方面存在抗栓治療不足,抗栓藥物,尤其是口服抗凝藥的用藥率低下,尚未達(dá)到預(yù)防缺血性腦卒中的理想水平。3.本次調(diào)查發(fā)現(xiàn),相比房顫患者的節(jié)律控制,其采用心室率控制的水平較高。而導(dǎo)管消融在房顫總體治療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.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R541.75

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3 陳云;急性冠狀動(dòng)脈綜合征抗栓治療中出血風(fēng)險(xiǎn)評(píng)估與處理[D];重慶醫(yī)科大學(xué);2015年

4 常愛娟;2004年度、2014年度心房顫動(dòng)病人發(fā)病及治療情況調(diào)查研究[D];北京中醫(yī)藥大學(xué);2016年

5 張瀛;全院2587例住院房顫患者資料的回顧性分析[D];山東大學(xué);2016年

6 賴仁奎;活血化瘀中藥聯(lián)合抗栓治療急性冠脈綜合征的療效性和安全性探討[D];廣州中醫(yī)藥大學(xué);2007年

7 李露;房顫患者抗栓治療及血管事件回顧性分析[D];重慶醫(yī)科大學(xué);2012年

8 唐偉良;心肌梗死伴發(fā)左室血栓抗栓治療的病例分析[D];浙江大學(xué);2011年

9 張雪松;老年非瓣膜性心房顫動(dòng)患者抗凝治療的調(diào)查分析[D];首都醫(yī)科大學(xué);2013年

10 馬改改;長期口服抗凝治療患者行經(jīng)皮冠狀動(dòng)脈介入治療術(shù)后應(yīng)用華法林聯(lián)合氯吡格雷抗栓治療方案的安全性和有效性分析[D];浙江大學(xué);2015年

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