方明

[摘要] 目的 探讨老年脑梗死并发心房颤动的抗凝治疗临床效果。 方法 选取我院2015年1月～2016年10月收治的120例老年脑梗死患者作为研究对象，了解其病例资料，根据是否存在既往房颤史进行分组，回顾性分析两组临床资料以及抗凝治疗效果。 结果 两组性别、年龄、吸烟史、合并高血压、高血脂以及糖尿病临床资料对比差异无统计学意义（P>0.05），但既往房颤组冠心病、甲状腺功能异常、既往脑梗死史患者比例明显高于既往无房颤组（P<0.05）；两组单独使用阿司匹林、华法林、氯吡格雷治疗患者比例以及INR值达标率对比差异不显著（P>0.05），另外既往房颤组双抗治疗患者比例明显高于既往无房颤组（P<0.05）。 结论 老年脑梗死并发心房颤动的抗凝治疗水平以及INR值达标率尚未达到理想水平，临床实践中应最大程度改善抗凝药物应用过程中出现的不便，以增强临床治疗效果。

[关键词] 老年；心房颤动；脑梗死；抗凝；INR值

[中图分类号] R541.75；R743.3 [文献标识码] B [文章编号] 1673-9701（2017）12-0101-03

[Abstract] Objective To investigate the clinical effect of anticoagulant therapy in elderly cerebral infarction patients combined with atrial fibrillation. Methods 120 patients with cerebral infarction in our hospital from January 2015 to October 2016 were enrolled. The clinical data were investigate. The patients were grouped according to whether the presence of previous history of atrial fibrillation. The clinical data as well as anticoagulant treatment effect between two groups were retrospectively analyzed. Results There was no significant difference in gender， age， smoking history， hypertension， hyperlipidemia and diabetes mellitus clinical data between two groups（P>0.05）. However， the proportion of patients with coronary heart disease， thyroid dysfunction and previous history of cerebral infarction in the previously atrial fibrillation group was significantly higher than that of the previously non-atrial fibrillation group（P<0.05）. There were no significant differences in the use of aspirin， warfarin and clopidogrel and INR values standard-reaching rate between the two groups（P>0.05）. In addition， The patients with double antibiotic treatment in the previously atrial fibrillation group were significantly more than those in previously non-atrial fibrillation group（P<0.05）. Conclusion The level of anticoagulation in elderly cerebral infarction complicated with atrial fibrillation and INR standard-reaching rate have not reached the ideal level. In clinical practice， the inconvenience of anticoagulant therapy should be improved in order to enhance the clinical therapeutic effect.

[Key words] Elderly； Atrial fibrillation； Cerebral infarction； Anticoagulation； INR value

心房顫动是临床常见的快速性心律失常，主要是指心房主导折返环引发的许多小折返环所致的房律紊乱。经研究发现心房颤动是脑梗死等脑血管疾病的独立危险因素，其并发脑梗死的几率是非房颤患者的2倍[1，2]。另外有学者调查显示，房颤患病率达0.5%，且发病率与年龄增长呈正比，其中≥80岁人群患病率可高达8.8%，其并发脑梗死的危险性明显更高[3]。因此临床中对于房颤患者予以有效的抗凝治疗，对预防脑血管事件具有重要的实践意义。本研究通过回顾性分析55例老年脑梗死并发心房颤动患者的临床资料，着重对抗凝治疗情况进行分析，现报道如下。

1资料与方法

1.1 临床资料

所选研究对象均为2015年1月～2016年10月收治的符合入选标准的120例老年脑梗死患者。纳入标准：所有患者均对本研究知情并签署知情同意书，经心电图以及24 h动态心电图明确诊断符合脑梗死并发心房颤动的诊断标准。排……