Summary of The Atrial Fibrillation Study Progress医学专业英语论文.doc
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1、Summary of The Atrial Fibrillation Study ProgressAbstract:Atrial fibrillation (AF) is the most commoncardiac arrhythmia,andarrhythmiafield ofthe most difficultto overcomeoneoftheheart disease. Chinaisthelargest country intheworldonpatients with atrial fibrillation, withtheimprovementofpeoples living
2、 standardand population aging, the incidence rateshowed an increasingtrendandbecomethe 21st centuryChinas emergingmainstreamof cardiovascular disease. Althoughatrial fibrillationis notlikeVFwill have a directcauseof death in patients, but therapidventricular rateinatrial fibrillationcan causehemodyn
3、amic deterioration, resulting in cardiacdysfunctionandmalignant ventricular arrhythmias, especially combinedthrombosiswill begreatly increasedin patients withtherisk of stroke. Effectivetestmethodcannotfindthetrackstate changesofatrial fibrillationandtreatmentof atrial fibrillationtreatmentare basic
4、allybasedontheclinicaltrial and error, leading to thedeclineintreatmentefficiency.In this paper, througha synthesis ofmodern researchonatrial fibrillation (AF), provideamore scientificbasistounderstandthe hazardsofatrial fibrillationandatrial fibrillationdiagnosis and treatment.Key words: atrial fib
5、rillationmechanism ESC OSASNew understanding of atrial fibrillation mechanismsBased on extensive research in recent years, clinical and basic, the ESC released a new atrial fibrillation treatment guidelines detailed mechanisms of atrial fibrillation: atrial factor (atrial pathophysiology, such as at
6、rial enlargement or fibrosis), electrophysiological mechanism (focal excited or reentrant, multiple micro-reentry, etc.), genetic factors (such as the cardiac sodium channel gene SCN5A adjustment function missing, etc.), clinically relevant factors (eg, hemodynamic changes) 1.New risk factors: obesi
7、ty and OSASObese patients with atrial fibrillation, the average body mass index (BMI) was 27.5 kg/m2, equivalent to when the moderately obese 3. Overweight and obesity can affect the atrial and ventricular structure and diastolic function, autonomic nerve function, suggesting a clear link between ob
8、esity and atrial fibrillation. The data show that obese people with atrial fibrillation relative risk is 1.5 times the normal individuals, and each increase in BMI to 1 kg/m2, the relative risk of atrial fibrillation increased by 4% 4.Sleep-disordered breathing sleep apnea syndrome (OSAS) increase a
9、trial pressure or excessive changes of autonomic tone can trigger atrial fibrillation. Repeated hemodynamic and hypoxic fluctuations can also activate the stretch sensitivity of ion channels and (or) catecholaminergic channel, resulting in a more active focal excited. OSAS associated with vagal refl
10、ex as a symbol (bradycardia) can lead to pulmonary vein antrum should not shorten the trigger focal excited. OSAS and elevated C-reactive protein is independently associated with cause of atrial fibrillation relative risk increase. Studies have shown that the prevalence of atrial fibrillation in pat
11、ients with OSAS was significantly higher than non-AF group (49% vs 32%, P 75 years old 2, new blood vessel disease, age 65 to 74 years of age, gender (female ) three risk factors. The recommendations of the new guidelines on the selection of oral anticoagulation: the choice of antithrombotic therapy
12、 should be based on the absolute risk of stroke, thromboembolism and bleeding and risk benefit ratio (I A). In addition to the low-risk patients (lone atrial fibrillation, age 65 years of age, hypertension = 2 points over the age of 65 women the hypertension CHA2DS2-VASc, score 3 points;Aspirin stat
13、us decline, and further enhance the status of oral anticoagulant drugs;Anticoagulant expressed as all or none, that the application or application of oral anticoagulation.European Heart Survey of HAS-BLED score high blood pressure, liver / renal dysfunction, stroke, history of bleeding or bleeding t
14、endency, the INR instability, elderly (age 65 years), drug / alcohol addiction, 1 minute assessment patients with atrial fibrillation anticoagulation risk of bleeding 7. Combined with the 2010 release of acute coronary syndrome or coronary intervention in patients with atrial fibrillation and antith
15、rombotic therapy consensus 8, the new guidelines emphasize the application of antithrombotic drugs (aspirin or clopidogrel) in patients with AF should be alert to bleeding, coronary stent implantation, specifically in the following table.Atrial fibrillation thromboembolism in high-risk (oral anticoa
16、gulation) in patients with coronary stent implantation anticoagulation strategyINR: International normalized ratioNecessary should be treated with proton pump inhibitors protect the gastric mucosaa: sirolimus, everolimus, tacrolimusb: joint use of vitamin K inhibitors (INR 2.0 to 2.5) + clopidogrel
17、75mg / day oral (or aspirin 100mg / day) oral administration of 12c: drug-eluting stents should be avoided, but if the implantation of drug-eluting stents, as necessary, to consider extending the triple the Anticoagulant time (3 to 6 months).ROCKET-AF study 10 is an atrial fibrillation anticoagulati
18、on, randomized double-blind controlled study, selected for the 1100 centers in 45 countries a total of 14 000 patients with atrial fibrillation were randomly assigned to coagulation factor Xa inhibitor rivaroxaban (oral 20mg / day, if moderate renal insufficiency compared to 15mg) or warfarin (oral
19、warfarin dose adjustment set INR of 2.5). More profit cutting classes and warfarin non-valvular atrial fibrillation stroke prevention. The study will be a higher risk of trial patients, 55% had a history of stroke, 90 percent have high blood pressure. In addition, 90% of patients CHADS2 score 3 poin
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