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目的了解近8年心房颤动(简称房颤)的病因变化和治疗策略转变情况,为临床防治提供参考。方法回顾性分析1998年1月至2005年12月在重庆医科大学附属第二医院心血管内科治疗资料完整的房颤患者839例,与1990年1月至1997年12月的房颤患者694例为对照。结果(1)近年来高血压(34.3%)、冠心病(29.4%)已超过风心病(20.5%)成为房颤的主要病因,老年患者增多(60岁以上者占68.3%)。(2)阵发性房颤多采用复律治疗(51.4%),药物多为胺碘酮(67%)、心律平(24%)。(3)慢性房颤治疗以控制心室率(76%)为主,药物选择为洋地黄类(39%)、β-受体阻滞剂(36%)、钙拮抗剂(25%),有不足1/2的持续性房颤患者试行复律。(4)抗血栓治疗以抗血小板为主(77.9%),药物多为阿司匹林,抗凝治疗(华法林)占10.1%。结论近8年来房颤的病因主要为高血压、冠心病,治疗策略以控制心室率为主,对于存在血栓高危因素者应以抗凝治疗为主,目前还存在抗凝治疗强度及剂量不足,控制心室率治疗不规范等问题。
Objective To understand the etiological changes of atrial fibrillation (AF) and the change of treatment strategies in recent 8 years, and provide reference for clinical prevention and treatment. Methods A retrospective analysis of 839 patients with atrial fibrillation in the Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University from January 1998 to December 2005 was performed. Compared with 694 patients with atrial fibrillation from January 1990 to December 1997 As a control. Results (1) In recent years, hypertension (34.3%) and coronary heart disease (29.4%) have surpassed rheumatic heart disease (20.5%) as the main cause of atrial fibrillation. Elderly patients increased (68.3%) over the age of 60 years. (2) Paroxysmal atrial fibrillation and more use of cardioversion therapy (51.4%), mostly amiodarone drugs (67%), heart rate (24%). (3) The treatment of chronic atrial fibrillation was mainly to control the ventricular rate (76%). The drug choice was digitalis (39%), β-blockers (36%), calcium antagonists Less than 1/2 patients with persistent atrial fibrillation trial cardioversion. (4) Antithrombotic therapy was mainly antiplatelet (77.9%), mostly aspirin and anticoagulant therapy (warfarin) accounted for 10.1%. Conclusion The main causes of atrial fibrillation in the recent 8 years are hypertension and coronary heart disease. The treatment strategy is mainly to control the ventricular rate. For the patients with high risk of thrombosis, anticoagulant therapy should be the main cause. There is still a lack of anticoagulant therapy, Control of ventricular rate is not standardized and other issues.