摘要目的:探讨高龄心房颤动(简称房颤)患者节律控制及心室率控制的治疗现状及可能影响其决策的相关因素。方法:回顾性分析，纳入2010年1月至2020年5月于北京医院保健医疗部住院治疗的年龄≥75岁的房颤患者，根据是否接受节律控制或心室率控制进行分组及比较，采用多因素logistic回归分析探究可能影响节律控制及心室率控制治疗决策的相关因素。结果:纳入167例高龄房颤患者，中位年龄90岁，21例(12.6%)接受节律控制，109例(65.3%)接受心室率控制。与未接受节律控制组比较，节律控制组患者年龄较小、BMI较大、舒张压较高，合并多重用药比例较高，合并慢性肾脏病3期或以上比例较低，血红蛋白水平较高(均 P<0.05)。与未接受心室率控制组比较，心室率控制组患者阵发性房颤比例较低，静息心室率较快，具有吸烟史比例较高，合并多重用药、冠心病、起搏器治疗、慢性阻塞性肺疾病和或哮喘的比例较高，合并认知障碍的比例较低(均 P<0.05)。多因素logistic回归分析显示，多重用药( OR＝11.578，95% CI：1.341~99.993， P＝0.026)与节律控制治疗正相关，慢性肾脏病3期或以上( OR＝0.248，95% CI：0.063~0.968， P＝0.045)与节律控制治疗负相关；多重用药( OR＝5.056，95% CI：2.253~11.347， P<0.001)、静息心室率( OR＝1.033，95% CI：1.005~1.062， P＝0.021)和慢性阻塞性肺疾病和/或哮喘( OR＝2.739，95% CI：1.124~6.672， P＝0.027)与心室率控制治疗正相关。 结论:高龄房颤患者节律控制治疗应用率低，以心室率控制为主。复杂的临床状态是主要制约因素，亟需基于前瞻性研究优化个体化策略并发展新型治疗技术以改善临床实践。

abstractsObjective:To explore the current therapeutic status of rhythm control versus rate control in elderly patients with atrial fibrillation(AF)and the related factors that may influence treatment decisions.Methods:A retrospective study was conducted on AF patients aged ≥75 years old who were hospitalized in the Healthcare Department of Beijing Hospital from January 2010 to May 2020.The patients were grouped and compared according to whether they underwent rhythm control or rate control.Multivariate logistic regression analysis was used to investigate the factors that may influence the treatment decision of rhythm control or rate control.Results:A total of 167 patients was included, with a median age of 90 years old.Among them, 21 patients(12.6%)received rhythm control, and 109 patients(65.3%)received rate control.Compared with the group not receiving rhythm control, the rhythm control group had a younger age, higher BMI, higher diastolic blood pressure, a higher proportion of multiple medication use, a lower proportion of chronic kidney disease stage 3 or above, and higher hemoglobin levels(all P<0.05). Compared with the group not receiving rate control, the rate control group had a lower proportion of paroxysmal AF, a faster resting ventricular rate, a higher proportion of smoking history, a higher proportion of multiple medication use, coronary heart disease, pacemaker treatment, chronic obstructive pulmonary disease and/or asthma, and a lower proportion of cognitive impairment(all P<0.05). Multivariate logistic regression analysis revealed that multiple drug use( OR=11.578, 95% CI: 1.341-99.993, P=0.026)was positively associated with rhythm control therapy, while chronic kidney disease stage 3 or above( OR=0.248, 95% CI: 0.063-0.968, P=0.045)was negatively associated with rhythm control therapy.For rate control therapy, multiple drug use( OR=5.056, 95% CI: 2.253-11.347, P<0.001), resting ventricular rate( OR =1.033, 95% CI: 1.005-1.062, P=0.021), and chronic obstructive pulmonary disease(COPD)and/or asthma( OR=2.739, 95% CI: 1.124-6.672, P=0.027)showed positive associations. Conclusions:The application rate of rhythm control therapy is low in elderly AF patients, and ventricular rate control is the main treatment.Complex clinical conditions are the main constraints, and it is urgent to optimize individualized strategies based on prospective studies and develop new treatment techniques to improve clinical practice.