中外医疗
中外醫療
중외의료
China Foreign Medical Treatment
2015年
28期
119-122
,共4页
华法林%非瓣膜性心房颤动%缺血性脑卒中
華法林%非瓣膜性心房顫動%缺血性腦卒中
화법림%비판막성심방전동%결혈성뇌졸중
Warfarin%Non-valvular atrial fibrillation%Ischemic stroke
目的 探讨华法林在非瓣膜性心房颤动患者抗凝治疗中预防缺血性脑中风效果及出血风险. 方法 整群选取2010年11月—2013年12月医院收治的172例非瓣膜性房颤患者为研究对象,按出血风险评分分为低危组及高危组,低危组口服华法林中等强度抗凝,国际标准化比率(INR)控制在2.0~3.0,高危组患者口服华法林低等强度抗凝,INR控制在1.5~2.5;观察记录两组患者治疗随访期间缺血性脑卒中风险与出血栓塞等不良反应情况. 结果 低危组缺血性脑卒中、短暂性脑缺血发作、外周动脉栓塞发生率(6.49%、2.60%、1.30%)与高危组(7.37%、3.16%、3.16%)比较,差异无统计学意义(P>0.05);低危组INR值(2.62±0.33),高危组INR值(1.86±0.31),两组比较差异有统计学意义(t=15.532,P<0.05);低危组死亡1例,高危组死亡2例,两组比较差异无统计学意义(P>0.05);低危组患者栓塞、出血、腹部不适发生率为9.09%、2.60%、1.30%,与高危组(9.47%、4.21%、2.11%)比较,差异无统计学意义(P>0.05);采用INR诊断患者出血风险,ROC曲线下面积为0.887(95%CI:0.827~0.946),INR的cut-off值2.85,该值下判断出血敏感性为81.1%,特异性为67.2%. 结论 华法林在非瓣膜性心房颤动患者抗凝治疗中,依据出血风险调整其抗凝强度可预防缺血性脑卒中及降低患者出血风险.
目的 探討華法林在非瓣膜性心房顫動患者抗凝治療中預防缺血性腦中風效果及齣血風險. 方法 整群選取2010年11月—2013年12月醫院收治的172例非瓣膜性房顫患者為研究對象,按齣血風險評分分為低危組及高危組,低危組口服華法林中等彊度抗凝,國際標準化比率(INR)控製在2.0~3.0,高危組患者口服華法林低等彊度抗凝,INR控製在1.5~2.5;觀察記錄兩組患者治療隨訪期間缺血性腦卒中風險與齣血栓塞等不良反應情況. 結果 低危組缺血性腦卒中、短暫性腦缺血髮作、外週動脈栓塞髮生率(6.49%、2.60%、1.30%)與高危組(7.37%、3.16%、3.16%)比較,差異無統計學意義(P>0.05);低危組INR值(2.62±0.33),高危組INR值(1.86±0.31),兩組比較差異有統計學意義(t=15.532,P<0.05);低危組死亡1例,高危組死亡2例,兩組比較差異無統計學意義(P>0.05);低危組患者栓塞、齣血、腹部不適髮生率為9.09%、2.60%、1.30%,與高危組(9.47%、4.21%、2.11%)比較,差異無統計學意義(P>0.05);採用INR診斷患者齣血風險,ROC麯線下麵積為0.887(95%CI:0.827~0.946),INR的cut-off值2.85,該值下判斷齣血敏感性為81.1%,特異性為67.2%. 結論 華法林在非瓣膜性心房顫動患者抗凝治療中,依據齣血風險調整其抗凝彊度可預防缺血性腦卒中及降低患者齣血風險.
목적 탐토화법림재비판막성심방전동환자항응치료중예방결혈성뇌중풍효과급출혈풍험. 방법 정군선취2010년11월—2013년12월의원수치적172례비판막성방전환자위연구대상,안출혈풍험평분분위저위조급고위조,저위조구복화법림중등강도항응,국제표준화비솔(INR)공제재2.0~3.0,고위조환자구복화법림저등강도항응,INR공제재1.5~2.5;관찰기록량조환자치료수방기간결혈성뇌졸중풍험여출혈전새등불량반응정황. 결과 저위조결혈성뇌졸중、단잠성뇌결혈발작、외주동맥전새발생솔(6.49%、2.60%、1.30%)여고위조(7.37%、3.16%、3.16%)비교,차이무통계학의의(P>0.05);저위조INR치(2.62±0.33),고위조INR치(1.86±0.31),량조비교차이유통계학의의(t=15.532,P<0.05);저위조사망1례,고위조사망2례,량조비교차이무통계학의의(P>0.05);저위조환자전새、출혈、복부불괄발생솔위9.09%、2.60%、1.30%,여고위조(9.47%、4.21%、2.11%)비교,차이무통계학의의(P>0.05);채용INR진단환자출혈풍험,ROC곡선하면적위0.887(95%CI:0.827~0.946),INR적cut-off치2.85,해치하판단출혈민감성위81.1%,특이성위67.2%. 결론 화법림재비판막성심방전동환자항응치료중,의거출혈풍험조정기항응강도가예방결혈성뇌졸중급강저환자출혈풍험.
Objective This aim is to explore the effect of warfarin in anticoagulation therapy of patients with non-valvular atrial fibrillation, and its prevention of ischemic stroke and bleeding risk in patients. Methods A total of 172 patients with non-valvular atrial fibrillation from November 2010 to December 2013 in our hospital were selected. They were divided into low risk group and high-risk groups according to the bleeding risk score. Patients in low-risk group were given moderate-intensity warfarin anticoagu-lation, international normalized ratio (INR) was controlled in 2.0~3.0, patients in high-risk group were given low intensity warfarin anticoagulation, INR was controlled in 1.5 ~2.5. Adverse reactions and ischemic stroke risk in two groups of patients were record-ed during follow-up. Results The ischemic stroke, transient ischemic attack, peripheral arterial embolism incidence in low-risk group was 6.49%, 2.60%, 1.30%, while it was 7.37%, 3.16%, 3.16% in the high-risk group, the difference was not statistically significance (P>0.05). INR value of low risk group was (2.62±0.33), which was (1.86±0.31) in high-risk group, there was statisti-cal difference between the groups (t=15.532, P<0.05). One patient died in low-risk group, 2 deaths in high-risk group, which was no significant difference (P>0.05). Embolism, bleeding, abdominal discomfort incidence rate in low-risk group was 9.09%, 2.60%, 1.30%, which was 9.47%, 4.21%, and 2.11%in high-risk group (P>0.05).The risk of bleeding in patients using INR diagnosis, the area under the ROC curve was 0.887 (95%CI:0.827~0.946), INR's cut-off value was 2.85, sensitive and specificity in this value judgment of bleeding risk was 81.1% and 67.2%. Conclusion The results show that warfarin in anticoagulation therapy of patients with non-valvular atrial fibrillation may prevent ischemic stroke and reduce the risk of bleeding, which according to risk of bleed-ing adjusting its intensity of anticoagulation in patients.
