心房颤动ABC综合管理路径影响老年房颤缺血性卒中结局的病例对照研究

doi:10.3969/j.issn.1003-9198.2024.04.004

摘要/Abstract

摘要： 目的研究在老年非瓣膜性心房颤动(房颤)病人中实施房颤综合管理(ABC路径)对缺血性卒中结局的影响。方法采用病例对照研究,选取129例新发缺血性卒中老年非瓣膜性房颤病人为病例组,匹配同期未发生缺血性卒中的非瓣膜性房颤病人258例为对照组。按照性别一致、年龄±2岁进行1∶2的频数匹配。比较2组病人房颤的管理情况、基础情况、临床指标、共病及药物使用情况。采用多因素条件Logistic回归分析ABC路径对房颤病人缺血性卒中结局的影响。结果 2组房颤管理方式,β受体阻滞剂、他汀药物、非维生素K拮抗剂使用率,血压、LDL-C水平,冠心病及既往卒中占比差异均有统计学意义(P<0.05)。条件Logistic回归分析显示,校正了冠心病、既往卒中/短暂性脑缺血发作、LDL-C后,与未抗凝管理的病人相比,抗凝管理的病人缺血性卒中发生风险降低63%(OR＝0.37,95%CI:0.17~0.82),而ABC路径病人的缺血性卒中发生风险降低81%(OR＝0.19,95%CI:0.08~0.47)。结论相比抗凝管理,ABC路径有进一步减少老年非瓣膜性房颤病人缺血性卒中风险的趋势。

关键词: 非瓣膜性房颤, 缺血性卒中, ABC路径, 抗凝管理

Abstract: Objective To investigate the impact of Atrial Fibrillation Better Care (ABC) pathway on the outcome of ischemic stroke in the elderly patients with non-valvular atrial fibrillation (AF). Methods A case-control study was conducted. A total of 129 elderly patients with non-valvular AF who experienced a new ischemic stroke were enrolled as the case group, and 258 elderly patients with non-valvular AF without ischemic stroke during the same period were enrolled as the control group. The two groups were matched in terms of gender, age ±2 with a ratio of 1∶2. The management of AF, baseline characteristics, clinical indicators, comorbidities and medication use were compared between the two groups. Multifactorial Logistic regression analysis was used to analyze the impact of anticoagulation management and the ABC pathway on the outcome of ischemic stroke in the elderly patients with non-valvular AF. Results Between the two groups, the differences in AF management, the usage rates of beta blocker, statin and non-vitamin K antagonists, the levels of blood pressure and low-density lipoprotein cholesterol(LDL-C), and the rates of coronary heart disease and stroke were statistically significant (P<0.05). Conditional Logistic regression analysis showed that after adjusting coronary heart disease, previous stroke/transient ischemic attack and LDL-C level, anticoagulation management was a protective factor of ischemic stroke (OR＝0.37, 95%CI: 0.17-0.82), and ABC pathway was a better protective factor of ischemic stroke (OR＝0.19, 95%CI: 0.08-0.47). Conclusions Compared with anticoagulation management, the ABC pathway shows a further trend of reducing the risk of ischemic stroke in the elderly patients with non-valvular AF.

Key words: non-valvular atrial fibrillation, ischemic stroke, ABC pathway, anticoagulation management

中图分类号:

R 541.75

周黎黎, 王伟, 窦毓, 熊亚晴. 心房颤动ABC综合管理路径影响老年房颤缺血性卒中结局的病例对照研究[J]. 实用老年医学, 2024, 38(4): 338-342.

ZHOU Lili, WANG Wei, DOU Yu, XIONG Yaqing. Impact of Atrial Fibrillation Better Care (ABC) pathway on outcome of ischemic stroke in elderly patients with atrial fibrillation: a case-control study[J]. Practical Geriatrics, 2024, 38(4): 338-342.

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