老年房颤患者华法林抗凝治疗社区管理与专科管理的对比研究

The Control Study of Community-Based Management and Specialist-Based Management of Warfarin Therapy in Elderly Patients with Atrial Fibrillation

目的:心房纤颤是老年最常见的心律失常之一,并且带来了如外周血管血栓形成、肺梗死、脑卒中等并发症。口服抗凝治疗是预防该类并发症的有效手段,但监测繁琐、有药物不良反应风险等。本实验为寻找有效的房颤管理模式,设计了社区管理模式,并与专科管理模式进行对照,以研究社区管理模式是否适合老年房颤患者的管理。方法:纳入在我院就诊的老年房颤患者107名,随机分入社区管理组及专科管理组,其中专科管理组患者在珠海市人民医院门诊常规就诊,而社区管理组在所属社区进行治疗。对照比较在抗凝达标率、华法林相关不良反应事件发生率(出血、血栓事件)、及费用方面的差异。结果:与专科管理组比较,社区管理组在抗凝达标率(分别为61.2%,64.2%,P>0.05)、出血及血栓事件(P值分别为0.133,0.279)发生率方面无明显统计学差异,但是在总体费用方面存在着统计学差异(P<0.001)。结论:老年房颤患者华法林抗凝治疗在社区管理有着与专科管理相似的可行性、安全性及有效性,并且有费用方面的优势。

Objective： Atrial fibrillation is one of the most common arrhythmia of the elderly,and it brought about some complications,such as peripheral vascular thrombosis,pulmonary infarction,stroke and others.Oral anticoagulant therapy is an effective means of prevention of such complications,but there are some problems,such as monitoring cumbersome,difficult treatment,and adverse drug reactions.For getting the effective management model of atrial fibrillation,in this study,we design a community-based management model which were compared with the specialist-based management model,and to examine the suitability of community-based management model for the management of elderly patients with atrial fibrillation in Zhuhai City.Methods： One hundred and seven elderly patients with atrial fibrillation were divided into two groups randomly,the patients of Specialist-based management group received conventional treatment in Zhuhai People＇s Hospital,and the patients of Community-based management group received treatment in their communities.To compare the attainment rate of the anticoagulant,warfarin-related adverse event rate（haemorrhage and thrombosis）,and total cost of two groups.Results： Compared to specialist-based management group,no significant statistical difference was found in attainment rate of the anticoagulant（61.2% vs 64.2%,P〉0.05） and the incidence rate of haemorrhage（P=0.133） and thrombosis（P=0.279）,but the significant statistical difference was found in the total cost（P〈0.001）.Conclusion： For the therapy of warfarin in elderly patients with atrial fibrillation in Zhuhai city,community-based management and specialist-based management get the similar feasibility,safety and effectiveness,and community-based management model has a better advantage in total cost.