永久性房颤患者151例抗栓治疗分析

目的：比较华法令与阿司匹林对永久性房颤患者脑卒中的预防作用及低强度抗凝的华法令对永久性房颤患者脑卒中预防的可行性。方法：151例永久性房颤患者根据本人意愿分为阿司匹林抗栓组及华法令抗栓组，华法令抗栓组又随机分为抵强度抗栓组（INR1．5～2．0）及标准强度抗栓组（INR2．1—3．0），阿司匹林抗栓组不监测国际标准化比值（INR），华发令抗栓组监测INR，根据INR调整华法令口服量。结果：平均随访3．8年，阿司匹林抗栓组、华法令低强度抗栓组、华法令标准强度抗栓组的缺血性脑卒中年发病率分别为9．09％、2．30％和1．05％。阿司匹林抗栓组缺血性脑率中的年发病率明显高于两组华法令抗栓组的缺血性脑卒中的年发病率，差异有显著性意义（P〈0．05）；但华法令标准强度抗栓组与华法令低强度抗栓组的缺血性脑卒中的年发病率无显著性差异（P〉0．05）。3组出血年发生率分别为1．04％、125％和6．32％，阿司匹林抗栓组与华法令低强度抗栓无显著性差异（P〉0．05），华法令标准强度抗栓组叫显高于阿司匹林抗栓组与华法令低强度抗栓，差异有显著性意义（P〈0．05）。结论：对于单纯房颤患者（低危人群）可以用阿司匹林抗栓治疗，非瓣膜性及高龄（〉75岁）房颤患者可考虑低强度华法令抗栓治疗，瓣膜性房颤患者仍需标准强度的华法令抗栓治疗。

Treatment of permanent atrial fibrillation with thrombolysis analysis of 151 cases

Objective:To Compare effects of warfarin and aspirin on permanent atrial fibrillation from aspect of preventing stroke; and to probe the feasibility of preventing atrial fibrillation patients from cerebral apoplexy with low-intensity warfarin. Methods: 151 patients were divided into aspirin group and warfarin group according to their own will. The warfarin group was randomly divided into low-intensity subgroup and standard-intensity subgroup. Results: An average duration of 3.8 years follow-up revealed that annual ischemic cerebral stroke incidence of the aspirin group is significant higher than that of the warfarin group (9.09% V.S. 2.30% and 1.05%) (P<0.05); however, there is no significant difference between the subgroups (P>0.05). The annual hemorrhagic stroke incidence of standard-intensity subgroup is significant higher than that of the aspirin group and low-intensity subgroup (6.32% V.S. 1.04% and 1.25%) (P<0.05). There is no significant difference between aspirin group and low-intensity subgroup (P>0.05). Conclusion: It is recommended simple atrial fibrillation patients can be treated with aspirin, non-valvular or senile atrial fibrillation patients, low-intensity warfarin might be ok. However valvular atrial fibrillation should be given standard-intensity warfarin.