心房颤动门诊病例的调查

探讨心房颤动 (简称房颤 )门诊病例的临床特点、伴随疾病、治疗情况和血栓栓塞并发症的患病率。收集2 0 0 3年 7月至 2 0 0 3年 10月来我院门诊就诊的 2 70例房颤患者的病例资料 ,登记患者的人口学特征、临床特点、伴随疾病、抗凝治疗和抗心律失常药物治疗情况以及血栓栓塞并发症的发生情况 ,观察房颤的发病特点和治疗情况。在 2 70例房颤中 ,男 14 7例 ,占 5 4 .4 % ;患者年龄 6 2 .0± 10 .1岁。其中阵发性房颤 93例 ,占 34.4 % ,慢性房颤 177例 ,占 6 5 .6 %。瓣膜性房颤 85例 ,占 31.5 % ,瓣膜性房颤和非瓣膜性房颤 (NVAF)患者中 ,血栓栓塞性疾病的患病率分别为 9.4 %和 9.2 %。瓣膜性房颤患者华法林的应用率为 95 .3% ,合并血栓栓塞危险因素的NVAF患者华法林应用率为 2 3.4 % ,应用华法林的患者就诊时国际标化率 <2 .0的占 5 7.6 %。阵发性房颤患者抗心律失常药物的应用率为 38.7% ,胺碘酮可引发甲状腺机能紊乱。结论 :门诊房颤患者以老龄患者为主 ,NVAF患者血栓栓塞事件的发生率高 ,华法林的应用率低 ,阵发性房颤患者应用抗心律失常药物不良反应发生率较高。

Investigation of Outpatients With Atrial Fibrillation

To evaluate the demographic and clinical characters of patients with atrial fibrillation who recently visited our clinic and survey their accompanying diseases, rate of thromboembolism and current status of treatment , two hundreds seventy consecutive patients with atrial fibrillation who visited our outpatient clinic between July to October 2003 were registered. Demographic and clinical features, antiarrhythmia drugs and anticoagulation usage, as well as the occurrence of ischemic events were recorded. Results: Among the 270 patients registered, 147 were male and 123 were female. Mean age of these patients were 62.0±10.1 years. Valvular atrial fibrillation account for 31.5% of this group of patients. The prevalence of thromboembolism events was 9.4% in valvular atrial fibrillation and 9.2% in nonvalvular atrial fibrillation(NVAF). The rate of warfarin utilization in valvular atrial fibrillation was 95.3%, while it′as low as 23.4% in patients with NVAF and high risk of thromboembolism. More than half of patients who received anticoagulation therapy had their INR<2.0 when they came to the clinic. The application of antiarrhythmia drugs in paroxysmal patients was common, occupied 38.7%, and it was not infrequent for patients taken amiodarone had disorganized thyroid. Conclusion: Old patients take a main part of atrial fibrillation in our clinic, accompanying a high incidence of thromboembolism events and low rate of warfarin usage. The prophylaxis of NVAF and it's complications should be highlighted in the clinical practice. Incidence of side effect of anti arrhythmia drugs in paroxysmal atrial fibrillation is relatively high, and the usage of these drug should be guarded.