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1、亚洲人群房颤后卒中现状及治疗进展DrKSLawrenceWongProfessorofMedicine&TherapeuticsChiefofNeurologyChineseUniversityofHongKong个案病史资料HistoryofAFSuddenonsetrighthemiparesisNIHStrokeScale13(moderatelysevere)PlainCT+/–contrastinA&ETreatmentoptions:rTPA:door-to-needletime(shouldbe<3–4.5 hou
2、rs)IAthrombolysis?Clotremoval?CTangiogramCTperfusionPenumbraclotremovalCardioembolicstrokeLargeclotCarotidstenosisArterytoarteryembolismsmallclotIntracranialatherosclerosis(MCA)Arterytoarteryembolism:smallerclotNIH.GOVCopyright©2006AmericanHeartAssociationMarderetal,
3、Stroke2006Thrombiwithentrappedcollectionsofbloodclot(topleftandright,bottom left),comparedwithanerythrocyte-predominantclot,presumablyformedinastaticareaafterembolicimpaction(bottomright)亚洲人群房颤患者的卒中预防流行病学房颤的流行现状及其危险性低患病率?Ryderetal,AmJCardiol1999StudySiteStudyPopulati
4、onAge(years)FemalePrevalenceWheeldonetal.Sheffield,UK1generalpractice≥65Overall5.4%65–692.3%70–744.1%75–795.8%80–846.4%≥858.1%Hilletal.Staffordshire,UK1generalpractice>65Overall3.7%65–693.4%70–742.7%75–793.4%80–845.4%≥855.9%Lipetal.Birmingham,UKTwogeneralpractices>50
5、Overall2.4%Lipetal.Birmingham,UKIndo-Asiansinsixgeneralpractices>50Overall0.6%Nakayamaetal.Shibata,JapanInvitedallresidents≥4058%Overall1.3%Loketal.HongKong,ChinaAmbulatoryparticipantsatsevenelderlycentres60–9485%Overall1.3%Kaushaletal.HimalayanVillage,IndiaAllreside
6、ntsover15Only14%>5456%Overall0.1%近期研究:中国人群的房颤流行现状19,368participants(8,636men,10,732 women)aged>35yearsTheage-adjustedprevalenceofAFinChineseadultsaged>35 yearswas0.74%inmenand0.72%inwomenTheprevalenceinsubjectsaged>60 yearswas1.83%inmenand1.92% inwomenZhang,Heart2009
7、房颤类型30.9%firstdiagnosed33.0%paroxysmalAF7.2%persistentAF28.9%permanentAFZhang,Heart2009中国人群的年龄校正后房颤发生率Maetal,CVDPreventionandControl2009AgeMale(%)Female(%)Total(%)30–3900040–490.30.20.250–590.50.60.560–691.41.11.370–703.62.63.180–77.57.47.5Total0.90.70.8亚洲人群房颤患者的卒中预防
8、病理生理学机制及严重程度不同的发病机制决定不同的严重程度CardioembolicstrokeLargeclotCarotidstenosisArterytoarteryembolismsmallclotIntracranialatherosclerosis(m
