新发房颤的急诊(jízhěn)处理第一页，共三十六页。房颤分类(fēnlèi)•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(huànzhě)无明显症状的房颤定义为沉默性房颤。第二页，共三十六页。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第三页，共三十六页。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(tóngshí)，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%。第四页，共三十六页。房颤，脑部的潜在(qiánzài)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,...
