健康教育对非瓣膜性心房颤动患者规范性抗凝的影响

Influence of health education for standard anticoagulation of non-valvular atrial fibrillation

目的研究不同的健康教育对非瓣膜性心房颤动(NVAF)患者规范性抗凝的影响。方法用数字表法将确诊的NVAF患者400例随机分为对照组和研究组各200例,记录基本资料,均给予常规宣教和治疗。将研究组随机均分为两个亚组,对知识讲座组患者和(或)家属进行心房颤动、华法林抗凝、用药方法、注意事项知识讲座和交流,知识手册组发放相关知识手册。分析研究组和对照组以及两个亚组间12个月后规范性抗凝、缺血性卒中、其他动脉栓塞、大出血、微量出血、死亡等方面的差异,比较两亚组资源耗费的差异。结果 (1)研究组规范性抗凝率(40.53%)高于对照组(15.96%)(χ2=28.11,P<0.01)。研究组缺血性卒中率(2.63%)低于对照组(7.45%)(χ2=4.49,P<0.05)。两组间动脉栓塞率、大出血率、微量出血率、死亡率比较,差异均无统计学意义(P>0.05)。(2)知识讲座组人均花费时间[(10.8±1.0)min]比知识手册组[(1.0±0.5)min]长(P<0.01),知识手册组人均成本[(5.1±1.1)元]比知识讲座组[(1.8±0.5)元]高(P<0.01)。(3)12个月后知识讲座组规范性抗凝率(47.96%)高于知识手册组(32.61%)(χ2=7.33,P<0.01),两组缺血性卒中、其他动脉栓塞、大出血、微出血、死亡率等比较,差异均无统计学意义(P>0.05)。结论详尽、正确的抗凝教育和指导能提高NVAF患者规范性抗凝率,并减少患者缺血性卒中的发生率。知识讲座的教育方式耗费时间更长,但更能提高患者的规范性抗凝率,为建立心房颤动规范的管理模式提供了理论依据。

Objective To explore the Influence of different health education approaches to standard anticoagulation of non-valvular atrial fibrillation. Methods 400 patients with NVAF were randomly divided into the research group （n=200） and the control group （n=200）. Baseline clinical information was recorded. Both groups were given regular education and treatment. The control group was randomly divided into two subgroups. One subgroup （patients or/and family members） was given knowledge lectures of atrial fibrillation, atrial fibrillation anticoagulant, and application of warfarin. The other was given the knowledge through booklets. Standard anticoagulation fulfillment rate, ischemic stroke, other events of artery embolism, major bleeding, minor bleeding and death in the two groups were observed after 1 year. The cost for different education approaches was also compared between the 2 subgroups.＆amp;nbsp;Results （1）In the research group, standard anticoagulation fullfillment rate （40.53%） was higher than that of the control group（15.96%） （P〈0.01）. The rate of ischemic stroke （2.63%） was also lower than the control group （4.49%） （χ2=4.49, P〈0.05）. The death rate was lower in the research group than those in the control group, but minor bleeding rate was higher, without statistically significance （P＆gt;0.05）.Other artery embolism rate , major bleeding, minor bleeding, death rate had no statistical difference. （2）Knowledge lecture group （10.8±1.0 min） spend more time than the booklet group （1.0±0.5 min） （P〈0.01）. The booklet group （5.1±1.1 yuan） costed more in terms of money than the knowledge lecture group （1.8±0.5 yuan） （P〈0.01）. （3）The knowledge lecture group showed higher standard anticoagulation fulfillment rate （47.96%） than that of booklet group （32.60%） （χ2=7.33, P〈0.01）. There was no statistical difference in ischemic stroke rate, other artery embolism rate, major bleeding rate, minor bleeding rate and the death rate. Conclusions Detailed, correct anticoagulant education and guidance can improve NVAF patients with standard anticoagulation, and reduce the risk of ischemic stroke. Knowledge lecture consumes more time but can improve the standard anticoagulation fulfillment rate.