心房顫動:修订间差异

求闻百科,共笔求闻
添加的内容 删除的内容
(修改自此处;原许可:CC BY-SA 3.0[网站升级迁移])
 
(机器人:清理不当的来源、移除无用的模板参数)
 

(未显示4个用户的5个中间版本)

第1行: 第1行:
{{other uses|心房撲}}
{{other uses|心房撲}}
{{medical}}
{{medical}}
{{Infobox medical condition (new)
{{Infobox medical condition (new)
| name = 心房顫<br/>Atrial fibrillation
| name = 心房顫<br/>Atrial fibrillation
| image = RapidAFib150 (cropped).jpg
| image = RapidAFib150 (cropped).jpg
| caption = [[心電圖]] 胸程V4V5的曲,可看出略微不律的心率,每分 150 次,同示出源自心房除的P波消失。
| caption = [[心电图]] 胸程V4V5的曲线,可看出略微不律的心率,每分 150 次,同示出源自心房除的P波消失。
| field = [[心臟病]]
| field = [[心臟病]]
| symptoms = 、[[心悸]]、[[昏厥]]、[[呼吸困难]]、[[心绞痛]]<ref name=Gray2010/><ref name=Mun2014/>
| symptoms = 、[[心悸]]、[[昏厥]]、[[呼吸困难]]、[[心绞痛]]<ref name=Gray2010/><ref name=Mun2014/>
| complications = [[心臟衰竭]]、[[失智症]]、[[中]]<ref name=Mun2014/>
| complications = [[心臟衰竭]]、[[失智症]]、[[中]]<ref name=Mun2014/>
| onset = 年逾 50<ref name=Zoni2014/>
| onset = 年逾 50<ref name=Zoni2014/>
| duration =
| duration =
| causes =
| causes =
| risks = [[高血]]、{{tsl|en|valvular heart disease|瓣膜性心臟病}}、[[冠狀動脈疾病]]、[[心肌症]]、[[先天性心臟病]]、[[慢性阻塞性肺病]]、[[睡眠呼吸暂停]]<ref name=Mun2014/><ref name=Anu2014/><ref name=Ng2013/>
| risks = [[高血]]、{{tsl|en|valvular heart disease|瓣膜性心臟病}}、[[冠狀动脉疾病]]、[[心肌症]]、[[先天性心臟病]]、[[慢性阻塞性肺病]]、[[睡眠呼吸暂停]]<ref name=Mun2014/><ref name=Anu2014/><ref name=Ng2013/>
| diagnosis = 感得到[[脉搏|搏跳]]、[[心电图]]<ref name=Ferg2013/>
| diagnosis = 感得到[[脉搏|搏跳]]、[[心电图]]<ref name=Ferg2013/>
| differential =[[心律不整]]<ref>{{cite book|last1=Hui|first1=David|last2=Leung|first2=Alexander A.|last3=Padwal|first3=Raj|title=Approach to Internal Medicine: A Resource Book for Clinical Practice|date=2015|publisher=Springer|isbn=9783319118215|page=45|url=https://books.google.ca/books?id=35uoCgAAQBAJ&pg=PA45|language=en|access-date=2017-07-29|archive-date=2020-12-08|archive-url=https://web.archive.org/web/20201208151924/https://books.google.ca/books?id=35uoCgAAQBAJ&pg=PA45|dead-url=no}}</ref>
| differential =[[心律不整]]<ref>{{cite book|last1=Hui|first1=David|last2=Leung|first2=Alexander A.|last3=Padwal|first3=Raj|title=Approach to Internal Medicine: A Resource Book for Clinical Practice|date=2015|publisher=Springer|isbn=9783319118215|page=45||language=en|access-date=2017-07-29}}</ref>
| prevention =
| prevention =
| treatment = 心跳速率控制或心跳奏控制<ref name=Anu2014/>
| treatment = 心跳速率控制或心跳奏控制<ref name=Anu2014/>
| medication =
| medication =
| prognosis =
| prognosis =
| frequency = 2.5% (已開發國家);0.5% (開發家)<ref name=Zoni2014/>
| frequency = 2.5% (已开发国家);0.5% (开发家)<ref name=Zoni2014/>
| deaths = 加上[[心房撲]]=193,300 人 (2015)<ref name=GBD2015De>{{cite journal|last1=GBD 2015 Mortality and Causes of Death|first1=Collaborators.|title=Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015.|journal=Lancet|date=8 October 2016|volume=388|issue=10053|pages=1459–1544|pmid=27733281|doi=10.1016/s0140-6736(16)31012-1}}</ref>
| deaths = 加上[[心房撲]]=193,300 人 (2015)<ref name=GBD2015De>{{cite journal|last1=GBD 2015 Mortality and Causes of Death|first1=Collaborators.|title=Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015.|journal=Lancet|date=2016-10-08|volume=388|issue=10053|pages=1459–1544|pmid=27733281|doi=10.1016/s0140-6736(16)31012-1}}</ref>
}}
}}


'''心房顫'''({{lang-en|Atrial fibrillation}},[[縮寫]]:{{lang|en|Af}}、{{lang|en|A-fib}}),又稱為'''心房微顫'''、'''房顫'''、'''心房纖性顫'''、'''心房纖顫'''、'''房性纖顫'''等,是[[心律不整]]的一,特色是心房快速而不規則的跳<ref>{{cite web|title=Heart Disease Other Related Conditions|url=http://www.cdc.gov/heartdisease/other_conditions.htm|website=cdc.gov|accessdate=19 February 2015|date=September 3, 2014|archive-date=2015-02-14|archive-url=https://web.archive.org/web/20150214234446/http://www.cdc.gov/heartdisease/other_conditions.htm|dead-url=no}}</ref>。
'''心房顫'''({{lang-en|Atrial fibrillation}},[[缩写]]:{{lang|en|Af}}、{{lang|en|A-fib}}),又称为'''心房微顫'''、'''房顫'''、'''心房纖性顫'''、'''心房纖顫'''、'''房性纖顫'''等,是[[心律不整]]的一,特色是心房快速而不规则的跳<ref>{{cite web|title=Heart Disease Other Related Conditions|url=http://www.cdc.gov/heartdisease/other_conditions.htm|website=cdc.gov|accessdate=2015-02-19|date=2014-09-03}}</ref>。


心房顫續時間長短有三,包含陣發性、持性及永久性。
心房顫续时间长短有三,包含阵发性、持性及永久性。


* 陣發性(Paroxysmal)心房顫- 時無, 持續時間不超七天。
* 阵发性(Paroxysmal)心房顫- 时无, 持续时间不超七天。
* 持性(Persistent)心房顫- 持續時間七天,但仍可以物或電擊整流回正常心律者。
* 持性(Persistent)心房顫- 持续时间七天,但仍可以物或电击整流回正常心律者。
* 永久性(Permanent)心房顫- 持一年以上,法以物或電擊整流回正常心律者<ref>{{Cite web|title=心房顫 -速率控制|url=http://www.afhealthcare.org.tw/index.php?action=info-in&cid=4&pid=7}}</ref>。
* 永久性(Permanent)心房顫- 持一年以上,法以物或电击整流回正常心律者<ref>{{Cite web|title=心房顫 -速率控制|url=http://www.afhealthcare.org.tw/index.php?action=info-in&cid=4&pid=7}}</ref>。


心房顫時間可能相短暫,但時間有可能越、甚至不緩解<ref name="Zoni2014">{{cite journal|last1=Zoni-Berisso|first1=M|last2=Lercari|first2=F|last3=Carazza|first3=T|last4=Domenicucci|first4=S|title=Epidemiology of atrial fibrillation: European perspective.|journal=Clinical epidemiology|date=2014|volume=6|pages=213-20|pmid=24966695|doi=10.2147/CLEP.S47385}}</ref>。大部分{{link-en|沒有症狀|Asymptomatic}},有病患到[[心悸]]、[[昏厥]]、[[呼吸困]]、[[胸痛]]<ref name="Gray2010">{{cite book|last1=Gray|first1=David|title=Chamberlain's Symptoms and Signs in Clinical Medicine: An Introduction to Medical Diagnosis|year=2010|publisher=Hodder Arnold|location=London|isbn=9780340974254|pages= [https://books.google.com/books?id=IXynWiryyjoC&pg=PA70 70–1]|edition=13th}}</ref>。心房顫動會增加[[心臟衰竭]]、[[失智症]]和[[中]]的危性<ref name="Mun2014" />。
心房顫时间可能相短暫,但时间有可能越、甚至不緩解<ref name="Zoni2014">{{cite journal|last1=Zoni-Berisso|first1=M|last2=Lercari|first2=F|last3=Carazza|first3=T|last4=Domenicucci|first4=S|title=Epidemiology of atrial fibrillation: European perspective.|journal=Clinical epidemiology|date=2014|volume=6|pages=213-20|pmid=24966695|doi=10.2147/CLEP.S47385}}</ref>。大部分{{link-en|沒有症狀|Asymptomatic}},有病患到[[心悸]]、[[昏厥]]、[[呼吸困]]、[[胸痛]]<ref name="Gray2010">{{cite book|last1=Gray|first1=David|title=Chamberlain's Symptoms and Signs in Clinical Medicine: An Introduction to Medical Diagnosis|year=2010|publisher=Hodder Arnold|location=London|isbn=9780340974254|pages= 70–1|edition=13th}}</ref>。心房顫动会增加[[心臟衰竭]]、[[失智症]]和[[中]]的危性<ref name="Mun2014" />。


心房顫床上最常的心律不整,患者每年有5%的風險,心臟瓣膜房顫患者中風險甚至更高。抗凝物,如[[香豆素]](coumarins)、[[乙酰水杨酸|阿司匹林]](Aspirin)、[[华法林|華法林]] (Wafrarin)、[[比加群|比加群酯]](Dabigatran)用預防。
心房顫床上最常的心律不整,患者每年有5%的风险,心臟瓣膜房顫患者中风险甚至更高。抗凝物,如[[香豆素]](coumarins)、[[乙酰水杨酸|阿司匹林]](Aspirin)、[[华法林]] (Wafrarin)、[[比加群|比加群酯]](Dabigatran)用預防。


== 病因與診斷 ==
== 病因与诊断 ==
[[高血]]和{{link-en|瓣膜性心臟病|vavular heart disease}}是造成心房顫兩個最常因子<ref name="Anu2014" /><ref name="Ng2013">{{cite journal|last1=Nguyen|first1=TN|last2=Hilmer|first2=SN|last3=Cumming|first3=RG|title=Review of epidemiology and management of atrial fibrillation in developing countries.|journal=International Journal of Cardiology|date=10 September 2013|volume=167|issue=6|pages=2412–20|pmid=23453870|doi=10.1016/j.ijcard.2013.01.184}}</ref>。其他和心臟相、也增加得到心房顫的危因子有:[[心臟衰竭]]、[[冠狀動脈疾病]]、[[心肌症]]和[[先天性心臟病]]<ref name="Anu2014">{{cite journal|last1=Anumonwo|first1=JM|last2=Kalifa|first2=J|title=Risk Factors and Genetics of Atrial Fibrillation.|journal=Cardiology clinics|date=November 2014|volume=32|issue=4|pages=485–494|pmid=25443231|doi=10.1016/j.ccl.2014.07.007}}</ref>。在发展中家,瓣膜性心臟病多半是因[[]]所造成<ref name="Kna2013">{{cite journal|last1=Mischke|first1=K|last2=Knackstedt|first2=C|last3=Marx|first3=N|last4=Vollmann|first4=D|title=Insights into atrial fibrillation.|journal=Minerva medica|date=April 2013|volume=104|issue=2|pages=119-30|pmid=23514988}}</ref>。和肺臟相增加得到心房顫的危因子有:[[慢性阻塞性肺病]]、[[肥胖症]]和[[睡眠呼吸中止症]]<ref name="Mun2014" />。其他危因子尚有:量[[乙醇|酒]]、[[糖尿病]]、[[甲狀腺功能亢症]]<ref name="Mun2014" /><ref name="Kna2013" />。然而,一半以上心房顫的病人沒有上述所的危因子<ref name="Mun2014" />。摸到紊的[[搏]]可以推可能患有此疾病,但診斷要靠[[心電圖]] <ref name="Ferg2013">{{cite journal |author=Ferguson C, Inglis SC, Newton PJ, Middleton S, Macdonald PS, Davidson PM |title=Atrial fibrillation: stroke prevention in focus |journal=ACC |volume=00 |issue=2 |pages=92–8 |year=2013 |pmid=24054541 |doi=10.1016/j.aucc.2013.08.002 |url=http://www.sciencedirect.com/science/article/pii/S1036731413001690 |last2=Inglis |last3=Newton |last4=Middleton |last5=MacDonald |last6=Davidson |access-date=2015-03-24 |archive-date=2015-09-24 |archive-url=https://web.archive.org/web/20150924183633/http://www.sciencedirect.com/science/article/pii/S1036731413001690 |dead-url=no }}</ref>,心電圖看到不規則的心室律及找不到代表心房律的{{tsl|en|P wave (electrocardiography)|P波 (心電圖)|P波}}<ref name="Ferg2013" />。
[[高血]]和{{link-en|瓣膜性心臟病|vavular heart disease}}是造成心房顫两个最常因子<ref name="Anu2014" /><ref name="Ng2013">{{cite journal|last1=Nguyen|first1=TN|last2=Hilmer|first2=SN|last3=Cumming|first3=RG|title=Review of epidemiology and management of atrial fibrillation in developing countries.|journal=International Journal of Cardiology|date=2013-09-10|volume=167|issue=6|pages=2412–20|pmid=23453870|doi=10.1016/j.ijcard.2013.01.184}}</ref>。其他和心臟相、也增加得到心房顫的危因子有:[[心臟衰竭]]、[[冠狀动脉疾病]]、[[心肌症]]和[[先天性心臟病]]<ref name="Anu2014">{{cite journal|last1=Anumonwo|first1=JM|last2=Kalifa|first2=J|title=Risk Factors and Genetics of Atrial Fibrillation.|journal=Cardiology clinics|date=2014-11|volume=32|issue=4|pages=485–494|pmid=25443231|doi=10.1016/j.ccl.2014.07.007}}</ref>。在发展中家,瓣膜性心臟病多半是因[[]]所造成<ref name="Kna2013">{{cite journal|last1=Mischke|first1=K|last2=Knackstedt|first2=C|last3=Marx|first3=N|last4=Vollmann|first4=D|title=Insights into atrial fibrillation.|journal=Minerva medica|date=2013-04|volume=104|issue=2|pages=119-30|pmid=23514988}}</ref>。和肺臟相增加得到心房顫的危因子有:[[慢性阻塞性肺病]]、[[肥胖症]]和[[睡眠呼吸中止症]]<ref name="Mun2014" />。其他危因子尚有:量[[乙醇|酒]]、[[糖尿病]]、[[甲狀腺功能亢症]]<ref name="Mun2014" /><ref name="Kna2013" />。然而,一半以上心房顫的病人沒有上述所的危因子<ref name="Mun2014" />。摸到紊的[[搏]]可以推可能患有此疾病,但诊断要靠[[心电图]] <ref name="Ferg2013">{{cite journal |author=Ferguson C, Inglis SC, Newton PJ, Middleton S, Macdonald PS, Davidson PM |title=Atrial fibrillation: stroke prevention in focus |journal=ACC |volume=00 |issue=2 |pages=92–8 |year=2013 |pmid=24054541 |doi=10.1016/j.aucc.2013.08.002 |url=http://www.sciencedirect.com/science/article/pii/S1036731413001690 |last2=Inglis |last3=Newton |last4=Middleton |last5=MacDonald |last6=Davidson |access-date=2015-03-24 }}</ref>,心电图看到不规则的心室律及找不到代表心房律的{{tsl|en|P wave (electrocardiography)|P波 (心电图)|P波}}<ref name="Ferg2013" />。


== 風險 ==
== 风险 ==
心房顫動會造成血液流不佳,因此心房的血液會較容易凝,在心房內產生血栓、血塊隨血液循流至,便堵住腦動脈而造成。根研究示,有心房顫的患者其的可能性是正常人5倍,且因心房顫所造成的中復發率高、預差。另,統計顯示,每20位心房顫患者就有1位在一年內發生中<ref>{{Cite journal|title=Reply to Mavrogenis et al.|url=http://dx.doi.org/10.1055/s-0042-110567|last=Gonzalez|first=Jean-Michel|last2=Barthet|first2=Marc|date=2016-09-26|journal=Endoscopy|issue=10|doi=10.1055/s-0042-110567|volume=48|pages=952–952|issn=0013-726X}}</ref>。因此,對於心房顫患者而言,如何有效預防中風發生是相重要的問題。<ref>{{Cite journal|title=Stroke patients with atrial fibrillation have a worse prognosis than patients without: data from the Austrian Stroke registry|url=https://doi.org/10.1016/j.ehj.2004.06.030|last=Steger|first=Christina|last2=Pratter|first2=Angelika|date=2004-10-01|journal=European Heart Journal|issue=19|doi=10.1016/j.ehj.2004.06.030|volume=25|pages=1734–1740|issn=0195-668X|last3=Martinek-Bregel|first3=Monika|last4=Avanzini|first4=Marion|last5=Valentin|first5=Andreas|last6=Slany|first6=Jörg|last7=Stöllberger|first7=Claudia}}</ref><ref name="自动生成1">{{Cite web|title=Stroke risk when you have atrial fibrillation|url=https://www.health.harvard.edu/heart-health/stroke-risk-when-you-have-atrial-fibrillation|accessdate=2021-03-22|last=Publishing|first=Harvard Health|work=Harvard Health|archive-date=2021-01-22|archive-url=https://web.archive.org/web/20210122023958/https://www.health.harvard.edu/heart-health/stroke-risk-when-you-have-atrial-fibrillation|dead-url=no}}</ref>心房顫病患罹患中一般人高,其中有79%的心房顫病患,其一生有16%的風險會發生中<ref>{{Cite web|title=IMPROVING DETECTION OF ATRIAL FIBRILLATION AFTER TRANSIENT ISCHAEMIC ATTACK AND STROKE|url=http://dx.doi.org/10.26226/morressier.5ab8f562d462b8029238d011|access-date=2021-11-11|date=2018-05-09|last=Ghosh|first=Madhura|work=dx.doi.org}}</ref>。
心房顫动会造成血液流不佳,因此心房的血液会较容易凝,在心房内产生血栓、血块随血液循流至,便堵住脑动脉而造成。根研究示,有心房顫的患者其的可能性是正常人5倍,且因心房顫所造成的中复发率高、預差。另,统计显示,每20位心房顫患者就有1位在一年内发生中<ref>{{Cite journal|title=Reply to Mavrogenis et al.|url=http://dx.doi.org/10.1055/s-0042-110567|last=Gonzalez|first=Jean-Michel|last2=Barthet|first2=Marc|date=2016-09-26|journal=Endoscopy|issue=10|doi=10.1055/s-0042-110567|volume=48|pages=952–952|issn=0013-726X}}</ref>。因此,对于心房顫患者而言,如何有效預防中风发生是相重要的问题。<ref>{{Cite journal|title=Stroke patients with atrial fibrillation have a worse prognosis than patients without: data from the Austrian Stroke registry|url=https://doi.org/10.1016/j.ehj.2004.06.030|last=Steger|first=Christina|last2=Pratter|first2=Angelika|date=2004-10-01|journal=European Heart Journal|issue=19|doi=10.1016/j.ehj.2004.06.030|volume=25|pages=1734–1740|issn=0195-668X|last3=Martinek-Bregel|first3=Monika|last4=Avanzini|first4=Marion|last5=Valentin|first5=Andreas|last6=Slany|first6=Jörg|last7=Stöllberger|first7=Claudia}}</ref><ref name="自动生成1">{{Cite web|title=Stroke risk when you have atrial fibrillation|url=https://www.health.harvard.edu/heart-health/stroke-risk-when-you-have-atrial-fibrillation|accessdate=2021-03-22|last=Publishing|first=Harvard Health|work=Harvard Health}}</ref>心房顫病患罹患中一般人高,其中有79%的心房顫病患,其一生有16%的风险会发生中<ref>{{Cite web|title=IMPROVING DETECTION OF ATRIAL FIBRILLATION AFTER TRANSIENT ISCHAEMIC ATTACK AND STROKE|url=http://dx.doi.org/10.26226/morressier.5ab8f562d462b8029238d011|access-date=2021-11-11|date=2018-05-09|last=Ghosh|first=Madhura|work=dx.doi.org}}</ref>。


然而,心房顫病患的中風風險並不相同。目前大多使用CHA<sub>2</sub>DS<sub>2</sub>-VASc分統來評估,分數範圍從0分到9分,分越高,表示每年的中風風險越高。多研究及指南皆建CHA<sub>2</sub>DS<sub>2</sub>-VASc分數為2或更高分的患者,且大部分都接受抗凝物的治預防降低中風險。<ref name="自动生成1" /><ref>{{Cite journal|title=Atomic models for the polypeptide backbones of myohemerythrin and hemerythrin|url=https://pubmed.ncbi.nlm.nih.gov/5|last=Hendrickson|first=W. A.|last2=Ward|first2=K. B.|date=1975-10-27|journal=Biochemical and Biophysical Research Communications|issue=4|doi=10.1016/0006-291x(75)90508-2|volume=66|pages=1349–1356|issn=1090-2104|pmid=5|access-date=2021-03-22|archive-date=2020-10-17|archive-url=https://web.archive.org/web/20201017100826/https://pubmed.ncbi.nlm.nih.gov/5/|dead-url=no}}</ref><ref>{{Cite journal|title=Effect of chloroquine on cultured fibroblasts: release of lysosomal hydrolases and inhibition of their uptake|url=https://pubmed.ncbi.nlm.nih.gov/4|last=Wiesmann|first=U. N.|last2=DiDonato|first2=S.|date=1975-10-27|journal=Biochemical and Biophysical Research Communications|issue=4|doi=10.1016/0006-291x(75)90506-9|volume=66|pages=1338–1343|issn=1090-2104|pmid=4|last3=Herschkowitz|first3=N. N.|access-date=2021-03-22|archive-date=2021-08-09|archive-url=https://web.archive.org/web/20210809225828/https://pubmed.ncbi.nlm.nih.gov/4/|dead-url=no}}</ref>此外,由病人的病況會隨時間應經估病人的CHA<sub>2</sub>DS<sub>2</sub>-VASc分,了解中風風險<ref>{{Cite web|title=project_intro_detail|url=http://www.hc.mmh.org.tw/webhc/project_intro_detail.aspx?project=7514&page=QA|access-date=2021-11-11|work=www.hc.mmh.org.tw}}</ref>。
然而,心房顫病患的中风风险并不相同。目前大多使用CHA<sub>2</sub>DS<sub>2</sub>-VASc分统来评估,分数范围从0分到9分,分越高,表示每年的中风风险越高。多研究及指南皆建CHA<sub>2</sub>DS<sub>2</sub>-VASc分数为2或更高分的患者,且大部分都接受抗凝物的治預防降低中风险。<ref name="自动生成1" /><ref>{{Cite journal|title=Atomic models for the polypeptide backbones of myohemerythrin and hemerythrin|url=https://pubmed.ncbi.nlm.nih.gov/5|last=Hendrickson|first=W. A.|last2=Ward|first2=K. B.|date=1975-10-27|journal=Biochemical and Biophysical Research Communications|issue=4|doi=10.1016/0006-291x(75)90508-2|volume=66|pages=1349–1356|issn=1090-2104|pmid=5|access-date=2021-03-22}}</ref><ref>{{Cite journal|title=Effect of chloroquine on cultured fibroblasts: release of lysosomal hydrolases and inhibition of their uptake|url=https://pubmed.ncbi.nlm.nih.gov/4|last=Wiesmann|first=U. N.|last2=DiDonato|first2=S.|date=1975-10-27|journal=Biochemical and Biophysical Research Communications|issue=4|doi=10.1016/0006-291x(75)90506-9|volume=66|pages=1338–1343|issn=1090-2104|pmid=4|last3=Herschkowitz|first3=N. N.|access-date=2021-03-22}}</ref>此外,由病人的病況会随时间应经估病人的CHA<sub>2</sub>DS<sub>2</sub>-VASc分,了解中风风险<ref>{{Cite web|title=project_intro_detail|url=http://www.hc.mmh.org.tw/webhc/project_intro_detail.aspx?project=7514&page=QA|access-date=2021-11-11|work=www.hc.mmh.org.tw}}</ref>。
{| class="wikitable"
{| class="wikitable"
| colspan="3" |CHA<sub>2</sub>DS<sub>2</sub>-VASc 分
| colspan="3" |CHA<sub>2</sub>DS<sub>2</sub>-VASc 分
|-
|-
|C
|C
第49行: 第49行:
|-
|-
|H
|H
|高血 Hypertension
|高血 Hypertension
|有:+1分
|有:+1分
|-
|-
|A2
|A2
|年齡 Age
|年齡 Age
|≧75:+2分
|≧75:+2分
|-
|-
|D
|D
第61行: 第61行:
|-
|-
|S2
|S2
|中Stroke/ TIA /血栓栓塞史
|中Stroke/ TIA /血栓栓塞史
|有:+2分
|有:+2分
|-
|-
|V
|V
|血管疾病 Vascular disease
|血管疾病 Vascular disease
|:0
|:0


有:+1分
有:+1分
第72行: 第72行:
|A
|A
|年齡 Age
|年齡 Age
|65-74:+1分
|65-74:+1分
|-
|-
|Sc
|Sc
|性
|性
|女性:+1分
|女性:+1分
|}
|}
此外,心房顫病患有高的比例會發生二次中(Secondary Stroke)。依據國際試驗顯示,13.2%的心房顫病患在中風後一年內發生二次中;在一次中風後確診心房顫的患者有10.9%生二次中<ref>{{Cite journal|title=Atrial Fibrillation Known Before or Detected After Stroke Share Similar Risk of Ischemic Stroke Recurrence and Death|url=https://pubmed.ncbi.nlm.nih.gov/31009353|last=Yang|first=Xiao-Meng|last2=Rao|first2=Zhen-Zhen|date=2019-05|journal=Stroke|issue=5|doi=10.1161/STROKEAHA.118.024176|volume=50|pages=1124–1129|issn=1524-4628|pmid=31009353|last3=Gu|first3=Hong-Qiu|last4=Zhao|first4=Xing-Quan|last5=Wang|first5=Chun-Juan|last6=Liu|first6=Li-Ping|last7=Liu|first7=Chelsea|last8=Wang|first8=Yi-Long|last9=Li|first9=Zi-Xiao}}</ref>。
此外,心房顫病患有高的比例会发生二次中(Secondary Stroke)。依据国际试验显示,13.2%的心房顫病患在中风后一年内发生二次中;在一次中风后确诊心房顫的患者有10.9%生二次中<ref>{{Cite journal|title=Atrial Fibrillation Known Before or Detected After Stroke Share Similar Risk of Ischemic Stroke Recurrence and Death|url=https://pubmed.ncbi.nlm.nih.gov/31009353|last=Yang|first=Xiao-Meng|last2=Rao|first2=Zhen-Zhen|date=2019-05|journal=Stroke|issue=5|doi=10.1161/STROKEAHA.118.024176|volume=50|pages=1124–1129|issn=1524-4628|pmid=31009353|last3=Gu|first3=Hong-Qiu|last4=Zhao|first4=Xing-Quan|last5=Wang|first5=Chun-Juan|last6=Liu|first6=Li-Ping|last7=Liu|first7=Chelsea|last8=Wang|first8=Yi-Long|last9=Li|first9=Zi-Xiao}}</ref>。


== 治 ==
== 治 ==
心房顫的治一般是用心跳速度降至接近正常的範圍(此治策略稱為速度控制,{{lang-en|rate control}})或是用規則的心律整流正常的[[竇房律]](此策略稱為心律控制,{{lang-en|rhythm control}})<ref name=Anu2014/>。{{link-en|電極心臟整流|Cardioversion}}可用於將心律整流正常的竇房律,病人生命象不常使用這個方法<ref>{{cite journal|last1=Oishi|first1=ML|last2=Xing|first2=S|title=Atrial fibrillation: management strategies in the emergency department.|journal=Emergency medicine practice|date=February 2013|volume=15|issue=2|pages=1-26; quiz 27|pmid=23369365}}</ref>。[[射燒灼]]可用防止心房顫的再<ref>{{cite journal|last1=Amerena|first1=JV|last2=Walters|first2=TE|last3=Mirzaee|first3=S|last4=Kalman|first4=JM|title=Update on the management of atrial fibrillation.|journal=The Medical journal of Australia|date=4 November 2013|volume=199|issue=9|pages=592–7|pmid=24182224|doi=10.5694/mja13.10191}}</ref>。
心房顫的治一般是用心跳速度降至接近正常的范围(此治策略称为速度控制,{{lang-en|rate control}})或是用规则的心律整流正常的[[竇房律]](此策略称为心律控制,{{lang-en|rhythm control}})<ref name=Anu2014/>。{{link-en|电极心臟整流|Cardioversion}}可用于将心律整流正常的竇房律,病人生命象不常使用这个方法<ref>{{cite journal|last1=Oishi|first1=ML|last2=Xing|first2=S|title=Atrial fibrillation: management strategies in the emergency department.|journal=Emergency medicine practice|date=2013-02|volume=15|issue=2|pages=1-26; quiz 27|pmid=23369365}}</ref>。[[射燒灼]]可用防止心房顫的再<ref>{{cite journal|last1=Amerena|first1=JV|last2=Walters|first2=TE|last3=Mirzaee|first3=S|last4=Kalman|first4=JM|title=Update on the management of atrial fibrillation.|journal=The Medical journal of Australia|date=2013-11-04|volume=199|issue=9|pages=592–7|pmid=24182224|doi=10.5694/mja13.10191}}</ref>。


而言,心房顫患者中風險是一般人的2-7倍<ref>{{Cite journal|title=Mortality and rate of stroke or embolism in atrial fibrillation during long-term follow-up in the embolism in left atrial thrombi (ELAT) study|url=http://dx.doi.org/10.1002/clc.4960270111|last=Stöllberger|first=Claudia|last2=Chnupa|first2=Pavel|date=2004-01|journal=Clinical Cardiology|issue=1|doi=10.1002/clc.4960270111|volume=27|pages=40–46|issn=0160-9289|last3=Abzieher|first3=Christine|last4=Länger|first4=Thomas|last5=Finsterer|first5=Josef|last6=Klem|first6=Igor|last7=Hartl|first7=Elisabeth|last8=Wehinger|first8=Cornelius|last9=Schneider|first9=Barbara}}</ref>,使用[[华法林|華法林]](Warfarin)可以預防患者生中70%,相較於[[乙酰水杨酸|阿斯匹林]](Aspirn)的20%有更著的效果<ref>{{Cite web|title=Faculty Opinions recommendation of Robotic magnetic navigation for atrial fibrillation ablation.|url=http://dx.doi.org/10.3410/f.12509.469991|access-date=2021-11-11|date=2006-04-11|last=Shen|first=Win-Kuang|work=Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature}}</ref>。不[https://www.escardio.org/Sub-specialty-communities/European-Heart-Rhythm-Association-(EHRA) 2018年洲心律學會](EHRA)治指引建,口服抗凝血的治優於[[华法林|華法林]](Warfarin)<ref>{{Cite journal|title=The 2018 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation: executive summary|url=http://dx.doi.org/10.5603/kp.2018.0180|last=Steffel|first=Jan|last2=Verhamme|first2=Peter|date=2018-09-07|journal=Kardiologia Polska|issue=9|doi=10.5603/kp.2018.0180|volume=76|pages=1283–1298|issn=1897-4279|last3=Potpara|first3=Tatjana S.|last4=Albaladejo|first4=Pierre|last5=Antz|first5=Matthias|last6=Desteghe|first6=Lien|last7=Haeusler|first7=Karl Georg|last8=Oldgren|first8=Jonas|last9=Reinecke|first9=Holger}}</ref>;在有新型抗凝血包括普栓(Dabigatran)、 拜瑞妥(Rivaroxaban)、艾必克凝(Apixaban)及里先安(Edoxaban),些新型口服抗凝血劑經大型試驗證實其預防中的效果不亞於傳統口服抗凝血,而且造成顱出血的風險降低,服患者如果突然遇到禍、跌倒、大量出血等需要行緊急手術時,目前部分新型口服抗凝血已有一反轉劑上市(如栓普(idarucizumab)),可以迅速恢凝血功能而病人接受手<ref>{{Cite web|title=中心律醫學會心房顫與併發症 心房顫物及非物治|url=http://thrs.org.tw/DB/Information/file/10/1.pdf}}</ref>。
而言,心房顫患者中风险是一般人的2-7倍<ref>{{Cite journal|title=Mortality and rate of stroke or embolism in atrial fibrillation during long-term follow-up in the embolism in left atrial thrombi (ELAT) study|url=http://dx.doi.org/10.1002/clc.4960270111|last=Stöllberger|first=Claudia|last2=Chnupa|first2=Pavel|date=2004-01|journal=Clinical Cardiology|issue=1|doi=10.1002/clc.4960270111|volume=27|pages=40–46|issn=0160-9289|last3=Abzieher|first3=Christine|last4=Länger|first4=Thomas|last5=Finsterer|first5=Josef|last6=Klem|first6=Igor|last7=Hartl|first7=Elisabeth|last8=Wehinger|first8=Cornelius|last9=Schneider|first9=Barbara}}</ref>,使用[[华法林]](Warfarin)可以預防患者生中70%,相较于[[乙酰水杨酸|阿斯匹林]](Aspirn)的20%有更著的效果<ref>{{Cite web|title=Faculty Opinions recommendation of Robotic magnetic navigation for atrial fibrillation ablation.|url=http://dx.doi.org/10.3410/f.12509.469991|access-date=2021-11-11|date=2006-04-11|last=Shen|first=Win-Kuang|work=Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature}}</ref>。不[https://www.escardio.org/Sub-specialty-communities/European-Heart-Rhythm-Association-(EHRA) 2018年洲心律学会](EHRA)治指引建,口服抗凝血的治优于[[华法林]](Warfarin)<ref>{{Cite journal|title=The 2018 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation: executive summary|url=http://dx.doi.org/10.5603/kp.2018.0180|last=Steffel|first=Jan|last2=Verhamme|first2=Peter|date=2018-09-07|journal=Kardiologia Polska|issue=9|doi=10.5603/kp.2018.0180|volume=76|pages=1283–1298|issn=1897-4279|last3=Potpara|first3=Tatjana S.|last4=Albaladejo|first4=Pierre|last5=Antz|first5=Matthias|last6=Desteghe|first6=Lien|last7=Haeusler|first7=Karl Georg|last8=Oldgren|first8=Jonas|last9=Reinecke|first9=Holger}}</ref>;在有新型抗凝血包括普栓(Dabigatran)、 拜瑞妥(Rivaroxaban)、艾必克凝(Apixaban)及里先安(Edoxaban),些新型口服抗凝血剂经大型试验证实其預防中的效果不亚于传统口服抗凝血,而且造成顱出血的风险降低,服患者如果突然遇到禍、跌倒、大量出血等需要行緊急手术时,目前部分新型口服抗凝血已有一反转剂上市(如栓普(idarucizumab)),可以迅速恢凝血功能而病人接受手<ref>{{Cite web|title=中心律医学会心房顫与并发症 心房顫物及非物治|url=http://thrs.org.tw/DB/Information/file/10/1.pdf}}</ref>。


== 流行病學與歷史 ==
== 流行病学与历史 ==
心房顫是最常之引發異常心臟跳的原因<ref name=Mun2014/>。依2014-2016年的調查估,中人口中有1.8%受心房顫,且罹患心房顫隨著而增加<ref>{{Cite journal|title=Atrial fibrillation prevalence, awareness and management in a nationwide survey of adults in China|url=http://dx.doi.org/10.1136/heartjnl-2020-317915|last=Du|first=Xin|last2=Guo|first2=Lizhu|date=2021-01-28|journal=Heart|issue=7|doi=10.1136/heartjnl-2020-317915|volume=107|pages=535–541|issn=1355-6037|last3=Xia|first3=Shijun|last4=Du|first4=Jing|last5=Anderson|first5=Craig|last6=Arima|first6=Hisatomi|last7=Huffman|first7=Mark|last8=Yuan|first8=Yiqiang|last9=Zheng|first9=Yang}}</ref>。全球疾病負擔(Global Burden of Disease, GBD)估2016年,全球有4630的心房顫患者<ref>{{Cite journal|title=Heart Disease and Stroke Statistics—2019 Update: A Report From the American Heart Association|url=https://www.ahajournals.org/doi/10.1161/CIR.0000000000000659|last=Benjamin|first=Emelia J.|last2=Muntner|first2=Paul|date=2019-03-05|journal=Circulation|issue=10|doi=10.1161/CIR.0000000000000659|volume=139|language=en|issn=0009-7322|last3=Alonso|first3=Alvaro|last4=Bittencourt|first4=Marcio S.|last5=Callaway|first5=Clifton W.|last6=Carson|first6=April P.|last7=Chamberlain|first7=Alanna M.|last8=Chang|first8=Alexander R.|last9=Cheng|first9=Susan}}</ref>。
心房顫是最常之引发异常心臟跳的原因<ref name=Mun2014/>。依2014-2016年的查估,中人口中有1.8%受心房顫,且罹患心房顫随着而增加<ref>{{Cite journal|title=Atrial fibrillation prevalence, awareness and management in a nationwide survey of adults in China|url=http://dx.doi.org/10.1136/heartjnl-2020-317915|last=Du|first=Xin|last2=Guo|first2=Lizhu|date=2021-01-28|journal=Heart|issue=7|doi=10.1136/heartjnl-2020-317915|volume=107|pages=535–541|issn=1355-6037|last3=Xia|first3=Shijun|last4=Du|first4=Jing|last5=Anderson|first5=Craig|last6=Arima|first6=Hisatomi|last7=Huffman|first7=Mark|last8=Yuan|first8=Yiqiang|last9=Zheng|first9=Yang}}</ref>。全球疾病负担(Global Burden of Disease, GBD)估2016年,全球有4630的心房顫患者<ref>{{Cite journal|title=Heart Disease and Stroke Statistics—2019 Update: A Report From the American Heart Association|url=https://www.ahajournals.org/doi/10.1161/CIR.0000000000000659|last=Benjamin|first=Emelia J.|last2=Muntner|first2=Paul|date=2019-03-05|journal=Circulation|issue=10|doi=10.1161/CIR.0000000000000659|volume=139|language=en|issn=0009-7322|last3=Alonso|first3=Alvaro|last4=Bittencourt|first4=Marcio S.|last5=Callaway|first5=Clifton W.|last6=Carson|first6=April P.|last7=Chamberlain|first7=Alanna M.|last8=Chang|first8=Alexander R.|last9=Cheng|first9=Susan}}</ref>。


而在[[開發家]],男性有0.6 %患有此一疾病,而有0.4%女性人口,亦受到心房顫的困擾。患有心房顫的人口比例隨著而增加,50以下的人口,有0.14%;而60至70的年齡提升4%;而一旦超8014 %的年有心房顫問題<ref name="Zoni2014" />。據統計,心房顫和[[心室纖]]在1990年造成29,000死亡病例,而至2018年,175,326位病患因心房顫而死亡<ref>{{Cite web|title=National Health Interview Survey, 1989: Multiple Cause of Death, Dates of Death, 1989-1991|url=http://dx.doi.org/10.3886/icpsr06478|access-date=2021-11-11|date=1995-06-05|work=ICPSR Data Holdings}}</ref>。而史上首次記錄脈常的告出自1749年法外科生{{link-en|尚巴提·德·塞|Jean-Baptiste de Sénac}};而首次利用心電圖記錄心房顫動過程者是1909年,由英的{{link-en|湯瑪斯·路易斯爵士|Thomas Lewis}}所完成<ref name="Mun2014">{{cite journal|last1=Munger|first1=TM|last2=Wu|first2=LQ|last3=Shen|first3=WK|title=Atrial fibrillation.|journal=Journal of biomedical research|date=January 2014|volume=28|issue=1|pages=1-17|pmid=24474959|doi=10.7555/JBR.28.20130191}}</ref>。
而在[[开发家]],男性有0.6 %患有此一疾病,而有0.4%女性人口,亦受到心房顫的困擾。患有心房顫的人口比例随着而增加,50以下的人口,有0.14%;而60至70的年齡提升4%;而一旦超8014 %的年有心房顫问题<ref name="Zoni2014" />。据统计,心房顫和[[心室纖]]在1990年造成29,000死亡病例,而至2018年,175,326位病患因心房顫而死亡<ref>{{Cite web|title=National Health Interview Survey, 1989: Multiple Cause of Death, Dates of Death, 1989-1991|url=http://dx.doi.org/10.3886/icpsr06478|access-date=2021-11-11|date=1995-06-05|work=ICPSR Data Holdings}}</ref>。而史上首次记录脉常的告出自1749年法外科生{{link-en|尚巴提·德·塞|Jean-Baptiste de Sénac}};而首次利用心电图记录心房顫动过程者是1909年,由英的{{link-en|汤玛斯·路易斯爵士|Thomas Lewis}}所完成<ref name="Mun2014">{{cite journal|last1=Munger|first1=TM|last2=Wu|first2=LQ|last3=Shen|first3=WK|title=Atrial fibrillation.|journal=Journal of biomedical research|date=2014-01|volume=28|issue=1|pages=1-17|pmid=24474959|doi=10.7555/JBR.28.20130191}}</ref>。


== 参见 ==
== 参见 ==
* [[心室顫]]
* [[心室顫]]


== 外部連結 ==
== 外部链接 ==
* {{cite news|url=http://mag.chinatimes.com/mag-cnt.aspx?artid=11621|date=2011-12-16|title=死亡率25% 心房顫手|author=邱玉珍|accessdate=2015-03-24|publisher=時報週刊|archive-url=https://web.archive.org/web/20150402112234/http://mag.chinatimes.com/mag-cnt.aspx?artid=11621|archive-date=2015-04-02|dead-url=yes}}
* {{cite news|url=http://mag.chinatimes.com/mag-cnt.aspx?artid=11621|date=2011-12-16|title=死亡率25% 心房顫手|author=邱玉珍|accessdate=2015-03-24|publisher=时报周刊|||}}
* [http://www.thrscare.org.tw/ 社法人中心律醫學會衛資訊網 (afhealthcare.org.tw)]
* [http://www.thrscare.org.tw/ 社法人中心律医学会卫资讯网 (afhealthcare.org.tw)]
* [http://thrs.org.tw/about/ 中心律醫學會|Taiwan Heart Rhythm Society (thrs.org.tw)]
* [http://thrs.org.tw/about/ 中心律医学会|Taiwan Heart Rhythm Society (thrs.org.tw)]
* [https://www.stroke.org.tw/GoWeb2/include/index.php?Page=5-1&paper02=13877796405bc97296a0b98 學會會訊:台灣腦風學會 (stroke.org.tw)]
* [https://www.stroke.org.tw/GoWeb2/include/index.php?Page=5-1&paper02=13877796405bc97296a0b98 学会会讯:台湾脑风学会 (stroke.org.tw)]
* [https://www.facebook.com/health.tw/videos/3118007874876684/ 【名公】心臟心中!心房顫吃抗凝血又怕大出血?]
* 【名公】心臟心中!心房顫吃抗凝血又怕大出血?


== 参考文献 ==
== 参考文献 ==
{{reflist|2}}
{{reflist}}

[[Category:心脏节律障碍]]
[[Category:心脏节律障碍]]