不同级别医院心房颤动/心房扑动急诊处理用药分析

赵翠; 朱俊; 刘明名; 冯广迅; 秦俭; 赵文献; 徐峰; 陈良; 李世国; 赵敏; 郭峰; 张春阳; 李琦; 艾芬; 付晓幸; 周文秀; 刘芳; 吕希俊; 梁岩

doi:10.13201/j.issn.1001-1439.2021.02.016

不同级别医院心房颤动/心房扑动急诊处理用药分析

- 1 中国医学科学院北京协和医学院阜外医院急重症中心(北京, 100037);
- 2 首都医科大学宣武医院急诊科;
- 3 北京普仁医院急诊科;
- 4 山东大学齐鲁医院急诊科;
- 5 济南市历下区人民医院急诊科;
- 6 中国医科大学附属盛京医院急诊科;
- 7 沈阳医学院附属中心医院急诊科;
- 8 武汉市中心医院急诊科;
- 9 武汉市亚心总医院重症医学科;
- 10 武汉市红十字会医院急诊科

详细信息

通讯作者: 梁岩,E-mail:fwliangyan2020@126.com

中图分类号: R541.7

收稿日期: 2020-10-08

Analysis on medications used in emergency treatment for atrial fibrillation/atrial flutter in different grade of hospitals

- 1 Emergency and Critical Care Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China;
- 2 Department of Emergency, Xuan Wu Hospital of Capital Medical University;
- 3 Department of Emergency, Beijing Puren Hospital;
- 4 Department of Emergency, Qilu Hospital, Shandong University;
- 5 Department of Emergency, Jinan Lixia District People's Hospital;
- 6 Department of Emergency, Shengjing Hospital, China Medical University;
- 7 Department of Emergency, Central Hospital Affiliated to Shenyang Medical College;
- 8 Department of Emergency, The Central Hospital of Wuhan;
- 9 Intensive Care Unit, Wuhan Asia General Hospital;
- 10 Department of Emergency, Wuhan Red Cross Hospital

More Information

Corresponding author: LIANG Yan, E-mail: fwliangyan2020@126.com

Received Date: 08 October 2020

摘要

摘要: 目的:调查各级别医院心房颤动(房颤)/心房扑动(房扑)急诊处理中的用药情况。方法:2016年1月—2019年12月共选取全国东北、华北、华东、华中等地区9家不同级别医院因房颤/房扑就诊的患者。采集人口统计学指标及药物治疗情况:抗心律失常药物、抗凝药物应用等情况。结果:共入选房颤/房扑399例,其急诊处理时各级别医院使用最多的抗心律失常药物为胺碘酮(64.1%),其中三级医院及二级医院高于心血管专科医院(69.2%∶41.3%,65.9%∶41.3%,P＜0.05)。各级别医院具有抗凝指征的非瓣膜房颤/房扑患者中启动长期口服抗凝药的患者占比均偏低,且三级医院及二级医院均低于心血管专科医院(22.2%:41.3%, 17.9%:41.3%,P＜0.05)。华法林为各级医院中应用最多的口服抗凝药物。结论:房颤/房扑急诊处理时的抗心律失常药物应用相对单一;各级别医院非瓣膜性房颤/房扑患者长期口服抗凝药物治疗比例仍低,三级医院及二级医院更为显著。房颤/房扑的急诊规范化治疗任务仍艰巨。
- 心房颤动 /
- 心房扑动 /
- 急诊处理 /
- 用药分析
Abstract: Objective: To investigate the medications used in emergency treatment for atrial fibrillation/atrial flutter in different grade of hospitals.Methods: Patients admitted to hospitals for atrial fibrillation/atrial flutter from January 2016 to December 2019 were enrolled. A total of 9 hospitals in Northeast, Eastern, North and Central China participated in the study. The demographic data and drug treatment(application of antiarrhythmic drugs(AADs) and anticoagulants administration were observed.Results: A total of 399 cases of atrial fibrillation/atrial flutter were assessed. Amiodarone(64.1%) was the most commonly used AADs during emergency treatment of atrial fibrillation/atrial flutter, and the proportion of it was significantly higher in tertiary and secondary hospitals than the cardiovascular specialist hospitals(69.2% vs 41.3%, 65.9% vs 41.3%, P＜0.05, respectively). The percentage of patients in non-valvular atrial fibrillation/atrial flutter(NVAF) with anticoagulant indications had started long-term oral anticoagulants was low in all grade of hospitals, and it was significantly lower in tertiary and secondary hospitals than the cardiovascular specialist hospitals(22.2% vs 41.3%, 17.9% vs 41.3%, P＜0.05, respectively), Warfarin was the most commonly used oral anticoagulant in all grade of hospitals.Conclusion: The drugs used in the emergency treatment of atrial fibrillation/atrial flutter in different grade of hospitals were simplex relatively; the proportion of anticoagulant therapy in NVAF was still low at all grade of hospitals, which were significantly lower in tertiary and secondary hospitals.
- atrial fibrillation /
- atrial flutter /
- emergency treatment /
- analysis of medication

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参考文献(21)

[1]	Wang Z,Chen Z,Wang X,et al.The disease burden of atrial fibrillation in china from a national cross-sectional survey[J].Am J Cardiol,2018,122(5):793-798.
[2]	中国心血管健康与疾病报告编写组.中国心血管健康与疾病报告2019概要[J].中国循环杂志,2020,35(9):833-854.
[3]	Svennberg E,Engdahl J,Al-Khalili F,et al.Mass screening for untreated atrial fibrillation:The STROKESTOP Study[J].Circulation,2015,131(25):2176-2184.
[4]	Collaborators G DaIIa P.Global,regional,and national incidence,prevalence,and years lived with disability for 354 diseases and injuries for 195 countries and territories,1990-2017:a systematic analysis for the Global Burden of Disease Study 2017[J].Lancet,2018,392(10159):1789-1858.
[5]	Lippi G,Sanchis-Gomar F,Cervellin G.Global epidemiology of atrial fibrillation:An increasing epidemic and public health challenge[J].Int J Stroke,2020:1747493019897870.DOI:10.1177/1747493019897870.
[6]	Hindricks G,Potpara T,Dagres N,et al.2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery(EACTS)[J].Eur Heart J,2020,Aug 29.DOI:10.1093/eurheartj/ehaa612.
[7]	January C T,Wann L S,Calkins H,et al.2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of patients with atrial fibrillation[J].Circulation,2019,140(2):e125-e151.
[8]	黄从新,张澍,黄德嘉,等.心房颤动:目前的认识和治疗建议(2018)[J].中华心律失常学杂志,2018,22(4):279-346.
[9]	Brugada J,Katritsis DG,Arbelo E,et al.2019 ESC guidelines for the management of patients with supraventricular tachycardiathe task force for the management of patients with supraventricular tachycardia of the european society of cardiology(ESC)[J].Eur Heart J,2020,41(5):655-720.
[10]	胺碘酮规范应用专家建议专家写作组.胺碘酮规范应用专家建议[J].中华内科杂志,2019,58(4):258-264.
[11]	Le DD,Levis JT,Lugovskaya N,et al.ECG diagnosis:ibutilide-induced torsade de pointes[J].Perm J,2019,23:18-187.
[12]	Vinson DR,Lugovskaya N,Warton EM,et al.Ibutilide effectiveness and safety in the cardioversion of atrial fibrillation and flutter in the community emergency department[J].Ann Emerg Med,2018,71(1):96-108.e2.
[13]	陈超峰,楚建民,王靖,等.伊布利特致心律失常及安全性评价[J].临床心血管病杂志,2017,33(11):1116-1119.
[14]	Pistoia F,Sacco S,Tiseo C,et al.The epidemiology of atrial fibrillation and stroke[J].Cardiol Clin,2016,34(2):255-268.
[15]	Caplan LR.Atrial fibrillation,past and future:from a stroke non-entity to an over-targeted cause[J].Cerebrovasc Dis,2018,45(3-4):149-153.
[16]	Delgado V,Di Biase L,Leung M,et al.Structure and function of the left atrium and left atrial appendage:AF and stroke implications[J].J Am Coll Cardiol,2017,70(25):3157-3172.
[17]	Benjamin EJ,Blaha MJ,Chiuve SE,et al.Heart disease and stroke statistics-2017 update:a report from the american heart association[J].Circulation,2017,135(10):e146-e603.
[18]	Seiffge DJ,Werring DJ,Paciaroni M,et al.Timing of anticoagulation after recent ischaemic stroke in patients with atrial fibrillation[J].Lancet Neurol,2019,18(1):117-126.
[19]	Chen YL,Lin YS,Wang HT,et al.Clinical outcomes of solitary atrial flutter patients using anticoagulation therapy:a national cohort study[J].Europace,2019,21(2):313-321.
[20]	胡志成,蒋超,郑黎晖,等.2019年中国心房颤动医疗质量控制报告[J].中国循环杂志,2020,35(5):427-37.
[21]	Piccini JP,Xu H,Cox M,et al.Adherence to guideline-directed stroke prevention therapy for atrial fibrillation is achievable[J].Circulation,2019,139(12):1497-1506.