新发房颤的急诊处理VIP免费

新发房颤的急诊处理房颤分类•初发房颤•阵发性房颤•持续性房颤•持久性房颤•慢性房颤•除此之外，因脑血栓或其他原因住院而发现房颤，患者无明显症状的房颤定义为沉默性房颤。名称临床特点心律失常类型初发房颤有症状的（首次发作）无症状的（首次发现）发生时间不明（首次发现）可复发，也可不复发阵发性房颤持续时间<7d（常<48h），能自行终止反复发作持续性房颤持续时间>7d非自限性反复发作持久性房颤持续时间>1年永久性房颤不能终止的终止后又复发的没有转复愿望的持续永久性AF发病率•Framingham研究表明，在50岁～60岁、60岁～70岁及70岁～80岁人群中房颤发病率分别为0.7%、3.5%和6.6%，而在>80岁人群中发病率高达16.3%。同时，男性发病率远高于女性，70～80岁男性发病率为9.1%，为该年龄组女性的2倍；>80岁男性发病率高达21.9%，而女性为12.5%。PAWolf,et.al,Atrialfibrillationasanindependentriskfactorforstroke:theFraminghamStudy.房颤，脑部的潜在威胁Comparedwithsubjectsfreeoftheseconditions,theage-adjustedincidenceofstrokewasmorethandoubledinthepresenceofcoronaryheartdisease(plessthan0.001)andmorethantrebledinthepresenceofhypertension(plessthan0.001).Therewasamorethanfourfoldexcessofstrokeinsubjectswithcardiacfailure(plessthan0.001)andanearfivefoldexcesswhenatrialfibrillationwaspresent(plessthan0.001).Inpersonswithcoronaryheartdiseaseorcardiacfailure,atrialfibrillationdoubledthestrokeriskinmenandtrebledtheriskinwomen.Withincreasingagetheeffectsofhypertension,coronaryheartdisease,andcardiacfailureontheriskofstrokebecameprogressivelyweaker(plessthan0.05).Advancingage,however,didnotreducethesignificantimpactofatrialfibrillation.Forpersonsaged80-89years,atrialfibrillationwasthesolecardiovascularconditiontoexertanindependenteffectonstrokeincidence(plessthan0.001).Theattributableriskofstrokeforallcardiovascularcontributorsdecreasedwithageexceptforatrialfibrillation,forwhichtheattributableriskincreasedsignificantly(plessthan0.01),risingfrom1.5%forthoseaged50-59yearsto23.5%forthoseaged80-89years.Whilethesefindingshighlighttheimpactofeachcardiovascularconditionontheriskofstroke,thedatasuggestthattheelderlyareparticularlyvulnerabletostrokewhenatrialfibrillationispresent.(ABSTRACTTRUNCATEDAT250WORDS)•1/3未曾接受治疗的AF病人会出现脑卒中•AF患者出现脑卒中的风险是无AF患者的4倍•伴随心衰或者冠心病患者中，AF使男性发生脑卒中的风险增加1倍，使女性发生脑卒中的风险增加2倍。•AF是唯一随年龄递增的脑卒中特特异心血管危险性因素。急性脑栓塞心源性占60-70%①起病急骤，以秒计；②既往有各种类型的心脏病、心房纤颤、心肌病、心肌梗死等病史，需注意特发性房颤造成脑栓塞占2.7％；③昏迷约占33％，抽搐高达25％，偏瘫常较完全；④有时可发现其他内脏或肢体的栓塞；⑤脑脊液检查压力正常或略高，常规检查可能有红细胞，说明有栓塞性出血的可能性；⑥头颅CT扫描检查和脑血栓形成相仿，但有时脑水肿较明显；有时在低密度区中有高密度灶存在，说明有栓塞性出血；有时可见多个低密度区，说明有多发性脑栓塞。AF合并脑卒中患者预后SaposnikG,et,al,AtrialFibrillationinIschemicStroke:PredictingResponsetoThrombolysisandClinicalOutcomes.Stroke.2012Nov20.Among12686patientswithanacuteischemicstroke,2185(17.2%)hadAF.Overall,AFpatientshadhigherriskofdeathat30days(22.3%versus10.2%;P<0.0001),1year(37.1%versus19.5%;P<0.0001)anddeathordisabilityatdischarge(69.7%versus54.7%;P<0.0001)comparedwithnon-AFpatients.Afteradjustment,thrombolysiswasassociatedwithafavorableoutcomeforpatientswithoutAF(relativerisk,1.18;95%CI,1.10-1.27),butnobenefitwasobservedforpatientswithAF(relativerisk,0.91;95%CI,0.71-1.17).Therewasamodes...