心房纤颤的围手术期管理课件

心房纤颤的围手术期管理,河南中医学院一附院心脏中心 关怀敏,心房纤颤分类,初发房颤（first-detected episode of AF） 阵发性房颤（paroxysmal AF） 持续性房颤（Persistent AF） 永久性房颤（permanent AF） 孤立性房颤（lone AF） 沉默性房颤（silent AF) 急性 (2448h之内) 长期 (1年),心房纤颤的流行病学,房颤的危害,增加死亡率 缺血性脑卒中 心功能降低 心肌缺血 生活质量和运动耐力下降 预防这些并发症是比较困难的！,房颤引发的卒中较其它病因者更为严重,Dulli DA, et al. Neuroepidemiology. 2003;22:118-123.,Odds ratio for bedridden state following stroke due to AF was 2.23 (95% CI, 1.87-2.59; p0.0005),房颤患者：生活质量下降,AF=atrial fibrillation; CAD=coronary artery disease; SF=Medical Outcomes Study Short Form 36 Adapted from: Dorian P, et al. J Am Coll Cardiol. 2000;36(4):13031309,Note that a lower score represents poorer quality of life. P0.001, compared with patients with AF.,SF-36 score,af,CAD,Control,Antiarrhythmic Drugs: Efficacy Maintaining NSR 6 Months,起搏器治疗房颤的新曙光,非瓣膜性房颤患者的卒中危险分层评估：CHADS2评分,CHADS2=cardiac failure, hypertension, age, diabetes, and stroke (doubled) 1. Reprinted from Curr Probl Cardiol, 30(4), Hersi A, et al, 175-233, Copyright 2005, with permission from Elsevier.,卒中年发生率与 CHADS2 评分具有良好的相关性1,CHADS2 score,卒中发生率 (%),口服抗凝药的临床应用: 仅约50患者接受了OAC治疗,NVAF=非瓣膜性房颤; RF=危险因素 1. Go AS, Hylek EM, Borowsky LH, et al. Ann Intern Med. 1999;131(12):927-34.,OAC的临床使用1,接受口服抗凝治疗的患者数1 随访11,082例瓣膜性房颤患者，接受口服抗凝药治疗: Total 55% 85 岁 35.4% 1卒中危险因素* 59.3% 理想的 患者 62.1% * Previous ischemic stroke, hypertension, congestive heart failure , diabetes mellitus and coronary heart disease. Risk factors, no contraindications, age 6574 years.,年龄,50%,华法林治疗,-,ACTIVE W: 治疗方案,多中心、多国、平行组、随机对照试验 口服抗凝药华法林 标准治疗 (INR 2.0 3.0) 至少每月测定一次INR 氯吡格雷联合阿司匹林治疗 氯吡格雷75 mg/d ASA 75-100 mg/d,ACTIVE Writing Group for the ACTIVE Investigators. Lancet. 2006;367:1903-1912,累计卒中发生风险：OAC优于波立维ASA,ACTIVE Writing Group for the ACTIVE Investigators. Lancet. 2006;367:1903-1912.,主要出血风险*,Cumulative Hazard Rates,Years,# at Risk C+A 3335 3172 2403 914 OAC 3371 3212 2423 901,2.42 %/year,2.21 %/year,RR = 1.1 (0.83-1.45) P = 0.53,.ACTIVE Writing Group for the ACTIVE Investigators. Lancet. 2006;367:1903-1912.,在卒中方面的获益最大,408(3.3%/年）,296(2.4%/年）,