Eur Heart J: 优化房颤治疗有4个环节!欧洲心脏杂志多项研究评述

2020-08-17 卢芳 中国循环杂志

我国35岁以上房颤患者超出487万例,中国心房颤动医疗质量控制报告显示,房颤治疗还有很大提升空间。

我国35岁以上房颤患者超出487万例,中国心房颤动医疗质量控制报告显示,房颤治疗还有很大提升空间。

如何管理好房颤,在其他国家也是个问题。

近日,欧洲心脏杂志主编Thomas F Lüscher结合最新一期该刊杂志发表的研究指出,优化房颤管理有4个环节:综合管理(包括抗凝管理)、控制血压、导管消融和左心耳封堵。

1、综合管理可延长房颤患者寿命

在一项名为“ALL-IN ”的组群随机试验发现,对于房颤患者,给予综合管理要比给予常规治疗,降低了45%的全因死亡风险和53%的非血管死亡风险。

这里的综合管理包括三部分:

(1)由接受过训练的专职护士季度性检查。同时关注和适当干预可能的并发症;

(2)监测抗凝情况;

(3)开通心脏科医生和抗凝门诊急诊便捷通道。

中国心房颤动医疗质量控制报告显示,我国房颤患者血栓栓塞风险评估不足50%,抗凝药处方不到60%,出血风险评估不到40%。或许借鉴这个综合管理,有助于“攻玉”。

2、降压要适度

高血压是房颤发生的重要危险因素,血压控制非常关键。

来自RE-LY试验的最新分析表明,接受抗凝治疗的房颤患者,与收缩压在120~130 mmHg这一范围相比,收缩压高于140 mmHg和低于120 mmHg增加全因死亡风险。

图1 接受口服抗凝房颤患者在较低收缩压水平时全因死亡和大出血风险增加,而在收缩压水平较高时脑卒中风险增加

研究还发现,收缩压140~160 mmHg时,栓塞风险则增加81%,≥160 mmHg时则风险增加了235%。

收缩压低于120 mmHg,患者大出血风险也增加。

与舒张压在70~80 mmHg相比,舒张压<70 mmHg增加55%的全因死亡风险,>90 mmHg增加88%的全因死亡风险。

此外较低(<70 mmHg)或较高的舒张压(80 mmHg到<90 mmHg)也会分别增加46%和13%的任何出血风险。

同期述评指出,低血压不仅有助于明确高危患者死亡风险,也有助于明确出血风险。

3、器械治疗有效

导管射频消融和左心耳封堵术也是治疗房颤的有效手段,在我国导管消融并发症发生率2.6%。

Thomas介绍,一项纳入11项研究3598例房颤合并心衰患者的分析结果显示,以导管消融作为节律控制的策略可明显改善生存率,降低再入院率,增加窦性心率维持率,进而保护心脏功能,改善生活治疗。

另一项研究中,英国学者应用AmplatzerTM AmuletTM封堵器对1088例患者进行了封堵,随访2年结果显示,缺血性脑卒中发生率要比预计中降低67%。

这种封堵器植入成功率在99.1%,术后7天内主要不良事件发生率为4%,包括死亡发生率为0.3%。随访可见,98.4%封堵成功,1.6%的患者发生设备相关血栓。

原始出处:Thomas F Lüscher, MD, FESC. Optimizing management of atrial fibrillation: integrated care, blood pressure control, ablation, and left atrial appendix occlusion. Eur Heart J,  11 August 2020

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    👍

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  4. [GetPortalCommentsPageByObjectIdResponse(id=811066, encodeId=c7f8811066b4, content=👍🏻, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=25e55411955, createdName=ms5000000741733160, createdTime=Wed Aug 19 16:27:08 CST 2020, time=2020-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=810868, encodeId=9798810868b3, content=!, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=25e55411955, createdName=ms5000000741733160, createdTime=Wed Aug 19 15:58:26 CST 2020, time=2020-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=810867, encodeId=7f8f81086e0d, content=👍, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=25e55411955, createdName=ms5000000741733160, createdTime=Wed Aug 19 15:58:25 CST 2020, time=2020-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1339348, encodeId=a5f613393481b, content=<a href='/topic/show?id=447663054f5' target=_blank style='color:#2F92EE;'>#欧洲#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63054, encryptionId=447663054f5, topicName=欧洲)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/PiajxSqBRaEKxsKDoOOFxGpMibw6lsQFUIicWt7kWGevkdgFhjiban1icD2JdIBmjVo7qX7aSlCSpiaia382nuLKiaI3Cg/132, createdBy=5c442500150, createdName=ms9474365431325850, createdTime=Wed Aug 19 05:21:40 CST 2020, time=2020-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1357592, encodeId=8603135e59219, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Wed Aug 19 05:21:40 CST 2020, time=2020-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1563360, encodeId=c84c1563360d1, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Wed Aug 19 05:21:40 CST 2020, time=2020-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=809908, encodeId=5d1e80990805, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=fb682417917, createdName=1238d654m87暂无昵称, createdTime=Mon Aug 17 21:36:09 CST 2020, time=2020-08-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1031296, encodeId=a92a1031296d6, content=房颤,临床上碰到很多哦, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=心介, createdTime=Mon Aug 17 17:21:40 CST 2020, time=2020-08-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=809704, encodeId=f58c809e04bf, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=81fb5092531, createdName=145d783em17暂无昵称, createdTime=Mon Aug 17 16:10:54 CST 2020, time=2020-08-17, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=811066, encodeId=c7f8811066b4, content=👍🏻, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=25e55411955, createdName=ms5000000741733160, createdTime=Wed Aug 19 16:27:08 CST 2020, time=2020-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=810868, encodeId=9798810868b3, content=!, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=25e55411955, createdName=ms5000000741733160, createdTime=Wed Aug 19 15:58:26 CST 2020, time=2020-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=810867, encodeId=7f8f81086e0d, content=👍, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=25e55411955, createdName=ms5000000741733160, createdTime=Wed Aug 19 15:58:25 CST 2020, time=2020-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1339348, encodeId=a5f613393481b, content=<a href='/topic/show?id=447663054f5' target=_blank style='color:#2F92EE;'>#欧洲#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63054, encryptionId=447663054f5, topicName=欧洲)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/PiajxSqBRaEKxsKDoOOFxGpMibw6lsQFUIicWt7kWGevkdgFhjiban1icD2JdIBmjVo7qX7aSlCSpiaia382nuLKiaI3Cg/132, createdBy=5c442500150, createdName=ms9474365431325850, createdTime=Wed Aug 19 05:21:40 CST 2020, time=2020-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1357592, encodeId=8603135e59219, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Wed Aug 19 05:21:40 CST 2020, time=2020-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1563360, encodeId=c84c1563360d1, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Wed Aug 19 05:21:40 CST 2020, time=2020-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=809908, encodeId=5d1e80990805, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=fb682417917, createdName=1238d654m87暂无昵称, createdTime=Mon Aug 17 21:36:09 CST 2020, time=2020-08-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1031296, encodeId=a92a1031296d6, content=房颤,临床上碰到很多哦, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=心介, createdTime=Mon Aug 17 17:21:40 CST 2020, time=2020-08-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=809704, encodeId=f58c809e04bf, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=81fb5092531, createdName=145d783em17暂无昵称, createdTime=Mon Aug 17 16:10:54 CST 2020, time=2020-08-17, status=1, ipAttribution=)]
    2020-08-19 zhaojie88
  6. [GetPortalCommentsPageByObjectIdResponse(id=811066, encodeId=c7f8811066b4, content=👍🏻, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=25e55411955, createdName=ms5000000741733160, createdTime=Wed Aug 19 16:27:08 CST 2020, time=2020-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=810868, encodeId=9798810868b3, content=!, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=25e55411955, createdName=ms5000000741733160, createdTime=Wed Aug 19 15:58:26 CST 2020, time=2020-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=810867, encodeId=7f8f81086e0d, content=👍, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=25e55411955, createdName=ms5000000741733160, createdTime=Wed Aug 19 15:58:25 CST 2020, time=2020-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1339348, encodeId=a5f613393481b, content=<a href='/topic/show?id=447663054f5' target=_blank style='color:#2F92EE;'>#欧洲#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63054, encryptionId=447663054f5, topicName=欧洲)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/PiajxSqBRaEKxsKDoOOFxGpMibw6lsQFUIicWt7kWGevkdgFhjiban1icD2JdIBmjVo7qX7aSlCSpiaia382nuLKiaI3Cg/132, createdBy=5c442500150, createdName=ms9474365431325850, createdTime=Wed Aug 19 05:21:40 CST 2020, time=2020-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1357592, encodeId=8603135e59219, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Wed Aug 19 05:21:40 CST 2020, time=2020-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1563360, encodeId=c84c1563360d1, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Wed Aug 19 05:21:40 CST 2020, time=2020-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=809908, encodeId=5d1e80990805, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=fb682417917, createdName=1238d654m87暂无昵称, createdTime=Mon Aug 17 21:36:09 CST 2020, time=2020-08-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1031296, encodeId=a92a1031296d6, content=房颤,临床上碰到很多哦, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=心介, createdTime=Mon Aug 17 17:21:40 CST 2020, time=2020-08-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=809704, encodeId=f58c809e04bf, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=81fb5092531, createdName=145d783em17暂无昵称, createdTime=Mon Aug 17 16:10:54 CST 2020, time=2020-08-17, status=1, ipAttribution=)]
    2020-08-19 slcumt
  7. [GetPortalCommentsPageByObjectIdResponse(id=811066, encodeId=c7f8811066b4, content=👍🏻, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=25e55411955, createdName=ms5000000741733160, createdTime=Wed Aug 19 16:27:08 CST 2020, time=2020-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=810868, encodeId=9798810868b3, content=!, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=25e55411955, createdName=ms5000000741733160, createdTime=Wed Aug 19 15:58:26 CST 2020, time=2020-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=810867, encodeId=7f8f81086e0d, content=👍, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=25e55411955, createdName=ms5000000741733160, createdTime=Wed Aug 19 15:58:25 CST 2020, time=2020-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1339348, encodeId=a5f613393481b, content=<a href='/topic/show?id=447663054f5' target=_blank style='color:#2F92EE;'>#欧洲#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63054, encryptionId=447663054f5, topicName=欧洲)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/PiajxSqBRaEKxsKDoOOFxGpMibw6lsQFUIicWt7kWGevkdgFhjiban1icD2JdIBmjVo7qX7aSlCSpiaia382nuLKiaI3Cg/132, createdBy=5c442500150, createdName=ms9474365431325850, createdTime=Wed Aug 19 05:21:40 CST 2020, time=2020-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1357592, encodeId=8603135e59219, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Wed Aug 19 05:21:40 CST 2020, time=2020-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1563360, encodeId=c84c1563360d1, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Wed Aug 19 05:21:40 CST 2020, time=2020-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=809908, encodeId=5d1e80990805, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=fb682417917, createdName=1238d654m87暂无昵称, createdTime=Mon Aug 17 21:36:09 CST 2020, time=2020-08-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1031296, encodeId=a92a1031296d6, content=房颤,临床上碰到很多哦, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=心介, createdTime=Mon Aug 17 17:21:40 CST 2020, time=2020-08-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=809704, encodeId=f58c809e04bf, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=81fb5092531, createdName=145d783em17暂无昵称, createdTime=Mon Aug 17 16:10:54 CST 2020, time=2020-08-17, status=1, ipAttribution=)]
    2020-08-17 1238d654m87暂无昵称

    0

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    2020-08-17 心介

    房颤,临床上碰到很多哦

    0

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    2020-08-17 145d783em17暂无昵称

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