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目的:对脑梗死合并房颤抗栓治疗的用药分布情况进行调查。方法:选取我院2012年1月至2015年1月间收治的249例脑梗死合并房颤患者,收集患者的人口学和临床资料,并以房颤出血评分(HASBLED评分)对患者进行出血风险评估。结果:本组249例脑梗死合并房颤患者中单独服用阿司匹林102例(40.96%),单独服用氯吡格雷49例(19.68%),合并服用阿司匹林+氯吡格雷双抗28例(11.24%),皮下注射低分子肝素7例(2.81%),服用华法林31例(12.45%),未用药32例(12.85%)。脑梗死合并房颤总抗栓治疗率87.15%(217例),明显高于未治疗率12.85%(32例),差异具有统计学意义(χ~2=274.900,P<0.05)。其中抗血小板治疗率71.89%(179例)明显高于抗凝治疗率15.26%(38例),差异具有统计学意义(χ~2=162.368,P<0.05)。根据HAS-BLED评分进行分组,157例HAS-BLED评分≥3分的患者中,抗血小板治疗121例(77.07%),抗凝治疗10例(6.37%),未用药26例(16.56%);92例HAS-BLED评分<3分的患者中,抗血小板治疗58例(63.04%),抗凝治疗28例(30.43%),未用药6例(6.52%)。HAS-BLED评分≥3分组的抗血小板治疗率和未治疗率高于HAS-BLED评分<3分组,而抗凝治疗率低于HAS-BLED评分<3分组,差异均具有统计学意义(P<0.05)。除HAS-BLED评分对抗栓治疗有较大影响外,性别、年龄、受教育程度、是否医保等因素均对抗栓治疗有一定的影响。结论:脑梗死合并房颤患者抗栓治疗中抗凝治疗的华法林用药率不足,出血风险的担忧是其主要的影响因素。而HAS-BLED评分能很好地对脑梗死合并房颤患者出血风险进行评估,从而决定其抗栓治疗的用药。
Objective: To investigate the distribution of antithrombotic therapy in patients with cerebral infarction complicated by atrial fibrillation. METHODS: A total of 249 patients with cerebral infarction and atrial fibrillation who were admitted to our hospital from January 2012 to January 2015 were enrolled in this study. The demographic and clinical data were collected and the risk of bleeding was assessed by the HASBLED score Evaluation. Results: A total of 102 patients (40.96%) took aspirin alone, 49 patients (19.68%) took clopidogrel alone, and 28 patients (11.24%) took aspirin + clopidogrel combined with 247 patients with atrial fibrillation. , Subcutaneous injection of low molecular weight heparin in 7 cases (2.81%), warfarin in 31 cases (12.45%) and no medication in 32 cases (12.85%). The total antithrombotic therapy rate of cerebral infarction with atrial fibrillation was 87.15% (217 cases), which was significantly higher than that of untreated cases (12.85%, 32 cases). The difference was statistically significant (χ ~ 2 = 274.900, P <0.05). The antiplatelet treatment rate was 71.89% (179 cases), which was significantly higher than that of anticoagulant therapy (15.26%, 38 cases), the difference was statistically significant (χ ~ 2 = 162.368, P <0.05). Among the 157 patients with HAS-BLED score≥3, 121 (77.07%) were treated with antiplatelet, 10 (6.37%) with anticoagulant therapy and 26 (16.56%) with no medication, according to the HAS-BLED score. Of the 92 patients with HAS-BLED score <3, 58 (63.04%) were antiplatelet, 28 (30.43%) were anticoagulant and 6 (6.52%) were unmedicated. The antiplatelet and untreated rate of HAS-BLED score ≥3 was higher than that of HAS-BLED score <3, and the rate of anticoagulant therapy was lower than that of HAS-BLED score <3, the difference was statistically significant (P < 0.05). In addition to the HAS-BLED score on the impact of antithrombotic therapy has a greater impact, gender, age, education level, whether health insurance and other factors have an impact on the antithrombotic therapy. Conclusion: Warfarin anticoagulant therapy in patients with cerebral infarction and atrial fibrillation is inadequate and the risk of hemorrhage is the main influencing factor. The HAS-BLED score is a good measure of the risk of bleeding in patients with cerebral infarction and atrial fibrillation, and thus determines the use of antithrombotic therapy.