机械心脏瓣膜置换术后华法林抗凝治疗的药学监护

Pharmaceutical Care on Anticoagulation Therapy Using Warfarin after Mechanical Prosthetic Valve Replacement

目的:探讨药学监护对心脏瓣膜置换术后应用华法林抗凝治疗患者生存质量的影响。方法:对48例接受华法林抗凝治疗的心脏瓣膜置换术患者进行用药教育、监测凝血酶原国际标准化比值、监测出血等不良反应。结果:患者在教育培训前、后抗凝知识评分分别为(4.78±0.52)和(10.23±0.41)分,自我管理能力评分分别为(4.15±1.25)和(10.55±0.20)分(P<0.05),出血事件13例,年龄、肝硬化与出血事件显著相关(P=0.046和P=0.016);血栓栓塞事件2例。结论:对使用华法林抗凝治疗患者进行药学监护能提高使用华法林的依从性,降低出血等并发症发生率。

Objective： To study the effect of pharmaceutical care on the patients receiving warfarin anticoagulation therapy after mechanical prosthetic valve replacements. Method： The medicine application knowledge was trained, international normalized ratio （INR） was detemined and adverse effects were watched in 48 cases of patients receiving warfarin anticoagulation therapy. Result： The average test score was（ 10.23 ± 0.41 ）after education and higher than that before education（4.78±0.52）（ P 〈 0.05 ）. The self-care skill and knowledge were improved（P 〈0.05）. There were 15 bleeding events occurred in 13 patients, and 2 events of thromboembolism were occurred. Age and hepatocirrhosis were significantly associated with bleeding complications （ P = 0. 046 and P = 0. 016）. Conclusion： Pharmaceutical care on anticoagulation therapy using warfarin improves therapy obedience and decreases adverse effects in hemorrhage and thrombosis.