基层医院房颤患者使用华法林抗凝治疗体会

Experience of Warfarin anticoagulant therapy for atrial fibrillation patients in primary hospital

目的探讨华法林在基层医院应用的并发症和随访率。方法将入选心内科住院并服用华法林的房颤患者42例作为观察组,纳入同期门诊房颤合并瓣膜病并行换瓣手术后服用华法林患者14例作为对照组,随访6个月,观察2组患者的随诊率、出血发生率、缺血性脑卒中发生率、病死率。结果 2组患者均无缺血性脑卒中发生,对照组按时随诊率100%,无并发症发生。观察组按时随诊率69.4%,发生出血并发症高达30.95%,其中脑出血死亡1例(2.4%);出血并发症全部发生在未按时随诊患者中,其中农村患者占84.60%。结论华法林预防缺血性脑卒中效果肯定,出血并发症主要出现在未按时随诊农村患者中,患者的依从性是华法林在基层医院应用的主要挑战。

Objective To investigate the complications and follow-up rate of warfarin application in primary hospital. Methods Twenty-four atrial fibrillation patients with warfarin administration in department of cardiology were enrolled as observation group. At the same period, fourteen atrial fibrillation patients with heart valve postoperation in clinic were enrolled as control group .The two group patients followed up for six months. The incidence of followed-up, ischemic, hemorrhagic stroke and mortality was observed for analysis. Results There were no ischemic stroke occurred in the two groups. The timely follow-up rate was 100% in control group,and there were no complications. The timely follow-up rate was 69.4% in observation group, and the hemorrhagic complications as high as 30.95%, in which there was one patient died of hemorrhagic stroke. All of the hemorrhagic complications took place in failing timely follow-up patients,in which the rual area patients accont for 84.60%.Conclusion Warfarin is effective in preventing ischemic stroke,The hemorrhagic complications mostly took place in rual area patients who failed timely follow-up,So the challenges of the application of warfarin in primary hospitals mainly come from the patients, compliance.