非瓣膜病性心房颤动患者规范性抗凝治疗方法的研究

Study on non-valvular atrial fibrillation treatment for the patients with standard anticoagulation

目的 研究提高非瓣膜病性心房颤动（房颤,NVAF）患者规范性抗凝率的方法。方法 将确诊的NVAF患者200例按数字表法随机分为观察组、对照组各100例,对照组给予常规的宣教和治疗,经过房颤知识、房颤抗凝知识和华法令治疗等培训及考核的研究人员对观察组进行房颤、抗凝、华法令用药方法及注意事项知识讲座及抗凝指导。观察比较1年后两组患者的规范性抗凝、缺血性卒中、大出血、微量出血、死亡等情况。结果 观察组1例、对照组2例失访。两组患者规范性抗凝率均低,总的规范性抗凝率仅为11.2%。观察组规范性抗凝率（36.4%）高于对照组（15.3%）（χ^2=6.75,P＜0.01）。观察组缺血性卒中率（2.0%）、病死率（1.0%）低于对照组（6.1%、2.0%）,微量出血率（7.1%）高于对照组（2.0%）,但差异均无统计学意义（均P＞0.05）,两组动脉栓塞率、大出血率差异均无统计学意义（均P＞0.05）。结论 详尽、正确的抗凝教育和指导可提高NVAF患者规范性抗凝率,有可能减少患者的栓塞特别是缺血性卒中的发生。

Objective To explore the method to improving non-valvular atrial fibrillation（NVAF） for the patients with standard anticoagulation rate.Methods 200 patients with NVAF were randomly divided into the observation group and control group,100 cases in each group.Control group was given conventional treatment of education,and through research and personnel training and assessment of atrial fibrillation anticoagulation knowledge,knowledge of warfarin therapy for atrial fibrillation,the observation group received anticoagulant,warfarin treatment methods and attention matters of lectures and anticoagulant guidance.Standard anticoagulation,ischemic stroke,major bleeding,minor bleeding,death in the two groups were observed after 1 year.Results The observation group 1 case,control group 2 cases were lost.Two groups of patients with standard anticoagulation rate was low,total rate of normative anticoagulation was only 11.2%.The observation group standard anticoagulation rate（36.4%） was higher than that of the control group（15.3%）（χ^2=6.75,P〈0.01）.The rate of ischemic stroke（2.0%） and mortality rate（1.0%） in the observation group was lower than those in the control group（6.1%,2.0%）.Minor bleeding rate（7.1%） of the observation group was higher than that of the control group（2.0%）,but the difference was not statistically significant（P〉0.05）.The arterial embolism and bleeding rate between two groups had no statistically significant differences（all P〉0.05）.Conclusion Detailed,correct health education and guidance can improve NVAF patients with standard anticoagulation rate,have the potential to reduce patients with embolism especially ischemic stroke.