专业护理人员在心房颤动抗凝管理体系中的作用评价

Evaluation of the role of professional nurses in atrial fibrillation anticoagulation management system

目的评价专业护理人员在心房颤动抗凝管理体系中的作用。方法本研究连续纳入217例接受导管消融治疗的非瓣膜病房颤患者，术后均口服华法林抗凝3-6个月。按照随机数字表法分为实验组102例与对照组115例。对照组患者出院时被告知服用华法林的剂量及注意事项，之后定期于心内科门诊复诊调整华法林剂量；实验组在一名经过培训的专业护士指导下调整华法林剂量。比较两组患者的国际标准化比率（INR）首次达标（INR值处于2．0～3．0）天数、有效抗凝（达标后，≥70％的INR监测值达标）率、INR达到目标值内的比例（达标后，INR处于2．0～3．0的次数占达标后总监测次数之比）及INR监测次数等指标。结果实验组的INR首次达标天数明显少于对照组（8d比15d，P〈0．01）；实验组有效抗凝率为45．1％（46／102），INR达到目标值内的比例（67．6±18．5）％，显著高于对照组的31．3％（36／115）和（62．0±23．1）％，P〈0．05；全程监测频率和INR达标后监测频次实验组为（9．4±2．2）次和（7．9±2.4）次，亦明显多于对照组的（84±2．7）次和（6．3±9．8）次，P〈0．01。对照组患者INR达标后监测频次≤3次的例数为18例，明显多于实验组的1例，P〈0．01。结论专业护士参与管理的房颤抗凝体系不仅有助于口服华法林抗凝的房颤患者INR尽早达标，还能有效提高华法林的抗凝达标率。

Objective To evaluate the effectiveness of professional nurses in atrial fibrillation （AF） anticoagulation management system. Methods 217 consecutive patients with nonvalvular AF were enrolled. All patients received warfarin therapy for 3-6 months after catheter ablation for AF, who were divided into experimental group （n=102） and control group （n=115） by random digits table. The patients of control group adjusted their warfarin doses by following doctor＇s advice when discharged and by visiting the outpatient clinic regularly after discharged. The patients of treatment group adjusted their warfarin doses under the guidance of one well- trained nurse. Days of the international normalized ratio （INR） value achieved therapeutic antieoagulation range （2.0-3.0） for the first time, the effective anticoagulation rate that defined as more than 70% of INR values between 2.0-3.0 after titration period, the ratio of times of INR value 2.0-3.0 to total times after titrating and INR monitoring frequency were compared between the 2 groups. Results In treatment group, days of the INR value achieved therapeutic 2.0-3.0 for the first time were less than that in control group （8 d vs. 15 d, P〈0.01）, the effective antieoagulation rate [ 45.1%（46/102） ] and the ratio of times of INR value 2.0-3.0 to total times after titrating （67.6%±18.5%） was significantly higher than that in control group [ 31.3%（36/115） and 62.0%±23.1% respectively, P〈0.05 ]. INR monitoring during the whole period and after titrating were more frequently in treatment group [ （9.4±2.2）times vs. （8.4±2.7） times,P〈0.05; （7.9±2.4） times vs. （6.3±2.8） times,P〈0.01 ]. The number of patients in treatment group who monitor INR less than 3 times after titrating was larger than that in control group （18 vs. 1, P〈0.01）. Conclusions The participation of professional nurses in atrial fibrillation anticoagulation management system was helpful not only in achieving INR 2.0-3.0 more quickly but also in improving the effective anticoagulation rate.