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专题:观点更新与解读,知识的扩容--房颤指南荟萃(内附沈法荣教授视频)

2017-03-31 MedSci MedSci原创

   房颤是一种以快速、无序心房电活动为特征的室上性快速性心律失常。心房因无序电活动而失去有效收缩,且房室结对快速心房激动呈现递减传导,造成极不规则心室律以及快速或缓慢心室率,导致心脏泵血功能下降,心房内附壁血栓形成。虽然房颤 本身是一种“良性”心律失常,不会直接引起死亡,但 房颤会显著降低患者的生存质量,并通过引起血栓、心衰等并发症间接增加死亡风险。近年来,房颤 的治疗发

   
房颤是一种以快速、无序心房电活动为特征的室上性快速性心律失常。心房因无序电活动而失去有效收缩,且房室结对快速心房激动呈现递减传导,造成极不规则心室律以及快速或缓慢心室率,导致心脏泵血功能下降,心房内附壁血栓形成。虽然房颤 本身是一种“良性”心律失常,不会直接引起死亡,但 房颤会显著降低患者的生存质量,并通过引起血栓、心衰等并发症间接增加死亡风险。近年来,房颤 的治疗发生了飞速发展,各种新兴理念应运而生。梅斯小编整理了房颤患者围手术期、手术期及管理指南,寄希望为外科医生治疗房颤提供一些帮助!
  
2017版指南敦促更多地使用手术以改善房颤患者的医疗护理。指南回顾了当前对房颤的认识,为3种临床情况提供了建议:房颤外科消融与二尖瓣手术同时进行,房颤外科消融与主动脉瓣手术或CABG同时进行,单独的房颤外科消融。指南呼吁更多的采用外科消融治疗房颤,认为这种方法有利于长期节律控制,改善患者生活质量和临床预后。
    二、2017年STS房颤外科消融治疗指南的解读

    2016年12月19日,美国胸外科医师学会(STS)发布了房颤外科消融临床实践指南,鼓励更多采用外科技术优化患者治疗。这份指南汇聚了顶尖的国际房颤外科治疗专家,包括圣路易斯华盛顿大学Damiano教授、密歇根大学Bolling教授、克利夫兰Gilllinov教授、芝加哥西北大学McCarthy教授、德克萨斯贝勒心脏中心Edgerton教授等,本文就该指南的相关要点进行了解读。首都医科大学附属北京安贞医院 张海波 孟旭
      三、
        
      2017年1月,美国心脏病学会(ACC)发布了非瓣膜性房颤患者围术期抗凝治疗的决策路径专家共识
         
      • 共识:非瓣膜性房颤患者围术期抗凝治疗的决策路径" target="_blank">2017 ACC专家共识:非瓣膜性房颤患者围术期抗凝治疗的决策路径
      • 四、房颤患者围术期如何抗凝管理?ACC发布临床决策共识
         
        长期口服抗凝治疗的房颤患者如何进行围术期管理,是非常棘手的问题,而且不同医院和医生的处理变化较大。针对这一临床难题,1月9日,美国心脏病学会(ACC)在线发表了非瓣膜性房颤患者围术期抗凝管理临床决策的专家共识文件。以下是指导推荐的要点总结。
          五、2016 ESC:欧洲房颤管理指南

          2016年8月,欧洲心脏病学会(ESC)发布了房颤管理指南,为ESC第2版房颤指南,指南涉及房颤的流行病学,病理学,诊断,分类和管理等内容。
            六、《2016年欧洲心脏病学会心房颤动管理指南》解读 

            《2016年ESC房颤指南》主要的亮点包括:(1) 房颤要早期发现,早期治疗,降低卒中的发生率。(2) 抗凝治疗方面,不推荐阿司匹林。对CHA2DS2-VASc 评分≥2 分的患者建议使用口服抗凝药物(OAC) ,优先选择新型口服抗凝药物( NOAC)。(3) 导管消融适应证更加扩宽。(4) 对房颤患者强调整体和整合的医护管理。首都医科大学附属北京朝阳医院心脏中心 杨新春

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              1. [GetPortalCommentsPageByObjectIdResponse(id=1681336, encodeId=d070168133610, content=<a href='/topic/show?id=366b8e2299e' target=_blank style='color:#2F92EE;'>#荟萃#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=87229, encryptionId=366b8e2299e, topicName=荟萃)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c12d27855367, createdName=venlin, createdTime=Sat Dec 16 06:50:00 CST 2017, time=2017-12-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1707428, encodeId=77b81e074281f, content=<a href='/topic/show?id=25df20e54dc' target=_blank style='color:#2F92EE;'>#专题#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20754, encryptionId=25df20e54dc, topicName=专题)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1f4231418733, createdName=108807375_62823137, createdTime=Mon Jun 12 09:50:00 CST 2017, time=2017-06-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=184241, encodeId=613018424191, content=不错的指南,为我们探讨研究提供了方针,给点个赞了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Sat Apr 01 09:14:34 CST 2017, time=2017-04-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=184007, encodeId=5e6b18400eee, content=签到学习了很多。, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://q.qlogo.cn/qqapp/1103841572/A3E53E62691178E2F18D7B999FD22131/100, createdBy=f44d2003846, createdName=Chongyang Zhang, createdTime=Fri Mar 31 13:01:51 CST 2017, time=2017-03-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=184005, encodeId=aa4d18400599, content=已经学习,谢谢分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRr4hYQTDrdLbsTChMzLetAadHkYtbdKribQFsv5vWbnhUYuQoVfqwW32yaOIO1BmBiaBPcSibicwgSAc/0, createdBy=5b192044357, createdName=流浪野医, createdTime=Fri Mar 31 12:52:19 CST 2017, time=2017-03-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=184004, encodeId=420f18400480, content=好!, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=118f1734484, createdName=1def5ef1m18(暂无匿称), createdTime=Fri Mar 31 12:44:28 CST 2017, time=2017-03-31, status=1, ipAttribution=)]
                2017-12-16 venlin
              2. [GetPortalCommentsPageByObjectIdResponse(id=1681336, encodeId=d070168133610, content=<a href='/topic/show?id=366b8e2299e' target=_blank style='color:#2F92EE;'>#荟萃#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=87229, encryptionId=366b8e2299e, topicName=荟萃)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c12d27855367, createdName=venlin, createdTime=Sat Dec 16 06:50:00 CST 2017, time=2017-12-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1707428, encodeId=77b81e074281f, content=<a href='/topic/show?id=25df20e54dc' target=_blank style='color:#2F92EE;'>#专题#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20754, encryptionId=25df20e54dc, topicName=专题)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1f4231418733, createdName=108807375_62823137, createdTime=Mon Jun 12 09:50:00 CST 2017, time=2017-06-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=184241, encodeId=613018424191, content=不错的指南,为我们探讨研究提供了方针,给点个赞了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Sat Apr 01 09:14:34 CST 2017, time=2017-04-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=184007, encodeId=5e6b18400eee, content=签到学习了很多。, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://q.qlogo.cn/qqapp/1103841572/A3E53E62691178E2F18D7B999FD22131/100, createdBy=f44d2003846, createdName=Chongyang Zhang, createdTime=Fri Mar 31 13:01:51 CST 2017, time=2017-03-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=184005, encodeId=aa4d18400599, content=已经学习,谢谢分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRr4hYQTDrdLbsTChMzLetAadHkYtbdKribQFsv5vWbnhUYuQoVfqwW32yaOIO1BmBiaBPcSibicwgSAc/0, createdBy=5b192044357, createdName=流浪野医, createdTime=Fri Mar 31 12:52:19 CST 2017, time=2017-03-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=184004, encodeId=420f18400480, content=好!, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=118f1734484, createdName=1def5ef1m18(暂无匿称), createdTime=Fri Mar 31 12:44:28 CST 2017, time=2017-03-31, status=1, ipAttribution=)]
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                2017-04-01 ylzr123

                不错的指南,为我们探讨研究提供了方针,给点个赞了!

                0

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                2017-03-31 Chongyang Zhang

                签到学习了很多。

                0

              5. [GetPortalCommentsPageByObjectIdResponse(id=1681336, encodeId=d070168133610, content=<a href='/topic/show?id=366b8e2299e' target=_blank style='color:#2F92EE;'>#荟萃#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=87229, encryptionId=366b8e2299e, topicName=荟萃)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c12d27855367, createdName=venlin, createdTime=Sat Dec 16 06:50:00 CST 2017, time=2017-12-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1707428, encodeId=77b81e074281f, content=<a href='/topic/show?id=25df20e54dc' target=_blank style='color:#2F92EE;'>#专题#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20754, encryptionId=25df20e54dc, topicName=专题)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1f4231418733, createdName=108807375_62823137, createdTime=Mon Jun 12 09:50:00 CST 2017, time=2017-06-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=184241, encodeId=613018424191, content=不错的指南,为我们探讨研究提供了方针,给点个赞了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Sat Apr 01 09:14:34 CST 2017, time=2017-04-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=184007, encodeId=5e6b18400eee, content=签到学习了很多。, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://q.qlogo.cn/qqapp/1103841572/A3E53E62691178E2F18D7B999FD22131/100, createdBy=f44d2003846, createdName=Chongyang Zhang, createdTime=Fri Mar 31 13:01:51 CST 2017, time=2017-03-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=184005, encodeId=aa4d18400599, content=已经学习,谢谢分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRr4hYQTDrdLbsTChMzLetAadHkYtbdKribQFsv5vWbnhUYuQoVfqwW32yaOIO1BmBiaBPcSibicwgSAc/0, createdBy=5b192044357, createdName=流浪野医, createdTime=Fri Mar 31 12:52:19 CST 2017, time=2017-03-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=184004, encodeId=420f18400480, content=好!, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=118f1734484, createdName=1def5ef1m18(暂无匿称), createdTime=Fri Mar 31 12:44:28 CST 2017, time=2017-03-31, status=1, ipAttribution=)]
                2017-03-31 流浪野医

                已经学习,谢谢分享!

                0

              6. [GetPortalCommentsPageByObjectIdResponse(id=1681336, encodeId=d070168133610, content=<a href='/topic/show?id=366b8e2299e' target=_blank style='color:#2F92EE;'>#荟萃#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=87229, encryptionId=366b8e2299e, topicName=荟萃)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c12d27855367, createdName=venlin, createdTime=Sat Dec 16 06:50:00 CST 2017, time=2017-12-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1707428, encodeId=77b81e074281f, content=<a href='/topic/show?id=25df20e54dc' target=_blank style='color:#2F92EE;'>#专题#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20754, encryptionId=25df20e54dc, topicName=专题)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1f4231418733, createdName=108807375_62823137, createdTime=Mon Jun 12 09:50:00 CST 2017, time=2017-06-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=184241, encodeId=613018424191, content=不错的指南,为我们探讨研究提供了方针,给点个赞了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Sat Apr 01 09:14:34 CST 2017, time=2017-04-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=184007, encodeId=5e6b18400eee, content=签到学习了很多。, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://q.qlogo.cn/qqapp/1103841572/A3E53E62691178E2F18D7B999FD22131/100, createdBy=f44d2003846, createdName=Chongyang Zhang, createdTime=Fri Mar 31 13:01:51 CST 2017, time=2017-03-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=184005, encodeId=aa4d18400599, content=已经学习,谢谢分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRr4hYQTDrdLbsTChMzLetAadHkYtbdKribQFsv5vWbnhUYuQoVfqwW32yaOIO1BmBiaBPcSibicwgSAc/0, createdBy=5b192044357, createdName=流浪野医, createdTime=Fri Mar 31 12:52:19 CST 2017, time=2017-03-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=184004, encodeId=420f18400480, content=好!, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=118f1734484, createdName=1def5ef1m18(暂无匿称), createdTime=Fri Mar 31 12:44:28 CST 2017, time=2017-03-31, status=1, ipAttribution=)]
                2017-03-31 1def5ef1m18(暂无匿称)

                好!

                0

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