张奇军　李　丹　俞　丽宁波市鄞州区第二医院心内科，浙江宁波　330200

基层医院心内科心房颤动住院患者华法林使用情况调查分析

张奇军李丹俞丽
宁波市鄞州区第二医院心内科，浙江宁波330200

目的调查分析基层医院心内科心房颤动住院患者华法林使用情况。方法通过对我院心内科住院病区2011年1～11月（A组）及2015年1～5月（B组）两组心房颤动患者的华法林使用情况进行调查及分析，并对治疗期间的出血并发症进行对比分析。结果两个时间段的华法林使用率均较低，结果显示两组间差异无统计学意义（χ2=3.213，P＞0.05），说明相隔4年，抗凝治疗并没有得到显著改善。两组治疗期间均出现脑出血、胃出血及肾脏、皮肤、黏膜、牙龈等部位出血，但两组出血并发症组间比较，差异无统计学意义（P＞0.05）。结论通过对华法林使用情况抗凝治疗过程中应严格按照相关指南规范治疗才能提高华法林的使用，使房颤患者获取最大受益。

华法林；抗凝；房颤；并发症

［Abstract］Objective To investigate and analyze the application situation of warfarin in the hospitalized patients with atrial fibrillation in the department of cardiology in primary hospital.M ethods The application situation ofwarfarin in the patients with atrial fibrillation who were hospitalized in the ward of cardiology in our hospital from January to November 2011（group A）and January to May 2015（group B）were investigated，contrasted and analyzed and the complication of bleeding during the treatmentwere compared and analyzed.Results The application ofwarfarin of patients from both groups were both relatively low and no significant differences were presented by the results（χ2=3.213，P＞0.05），indicating that after 4 years，no significant improvement was seen in the anti-coagulation treatment.Cerebral hemorrhage，gastrorrhagia and bleeding at the kidney，skin，mucosa and gingivawas presented in the patients from both groups during the treatment with no significant differences（P＞0.05）.Conclusion Related guideline should be followed strictly when using warfarin in the coagulation treatment，which can increase the efficacy of warfarin and benefit the patients with atrial fibrillation to themost.

［Key words］Warfarin；Coagulation；Atrial fibrillation；Complication

心房颤动（房颤）是老年人最常见的持续性心律失常，其发病率随年龄增加而增加，亦随器质性心脏病之出现而升高。血栓栓塞性并发症是房颤致死致残的主要原因，而卒中是最为常见的表现类型。在非瓣膜性房颤患者中，房颤引起的缺血性卒中是非房颤者的5倍［1］。15%～20%的卒中由房颤导致，而房颤患者卒中年发生率为3%～4%。房颤所致的卒中危害严重，其在1年内增加死亡率和致残率近l倍，复发风险更是增加4.7倍。自上世纪90年代以后发表的大量随机临床研究证实，老年房颤患者中与安慰剂相比，应用华法林可以明显降低卒中危险达67%，疗效高于其他抗凝药和抗血小板药［2］，75岁以上房颤患者应用华法林比用抗血小板药降低卒中更有效［3］。……