机械瓣膜置换术后华法林抗凝致出血并发症的影响因素分析

Analysis of the Influencing Factors of Warfarin Anticoagulation Induced Bleeding Complications after Mechanical Valve Replacement

目的 分析机械瓣膜置换术后华法林抗凝致出血并发症的影响因素。方法 选取我院2014年10月~2015年10月收治的132例机械瓣膜置换术后以华法林抗凝的患者为研究对象,按有无出血并发症分为观察组（57例）和对照组（75例）。回顾性分析所有研究对象的病案资料,包括性别、年龄、病程、瓣膜置换数量、文化程度、主动脉阻断时间、体外循环时间、血压、家庭收入、抽烟史、饮酒史、合并疾病、抗凝认知程度及依从性等,单因素及多因素Logistic回归分析。结果 较对照组,观察组女性、病程〉5年、文化程度大专以下、吸烟史、有合并疾病、抗凝认知程度差、抗凝依从性差者占比68.42%、61.40%、77.19%、54.39%、50.88%、78.95%、73.68%高,上述指标两组比较差异均有统计学意义（P〈0.05）;多因素Logistic回归分析结果显示,学历大专以下、抗凝认知差、抗凝治疗依从性差与机械瓣膜置换术后华法林抗凝致出血并发症发生有显著相关性,OR值分别为2.856、3.138和3.656。结论 病程〉5年、抗凝认知差、治疗依从性差均为机械瓣膜置换术后华法林抗凝致出血并发症的主要影响因素。

Objective To analyze the influencing factors of warfarin anticoagulation induced bleeding complications after mechanical valve replacement. Methods 132 patients who underwent warfarin anticoagulation after mechanical valve replacement in our hospital between October 2014 and October 2015 were selected as the study objects. According to with or without bleeding complications,the patients were divided into the observation group（ 57 cases） and the control group（ 75 cases）. The medical record data of all subjects were retrospectively analyzed,including gender,age,course of disease,valvular replacement quantity,educational level,aortic cross clamp time,cardiopulmonary bypass time,blood pressure,family income,smoking history,drinking history,complications,cognitive degree of anticoagulation and compliance,etc.. Univariate and multivariate Logistic regression analysis were performed. Results The proportions of patients who were female,whose course of disease 〉5 years,educational level lower than junior college,smoking history,with complications,poor cognitive degree of anticoagulation and poor compliance of anticoagulant therapy in the observation group（ 68. 42%,61. 40%,77. 19%,54. 39%,50. 88%,78. 95%,73. 68%） were higher than those in the control group（ P〈0. 05）; Multivariate logistic regression analysis showed that educational level lower than junior college,poor cognitive degree of anticoagulation and poor compliance of anticoagulation therapy were significantly correlated with warfarin anticoagulation induced bleeding complications after mechanical valve replacement（ OR = 2. 856,3. 138,3. 656）. Conclusion Course of disease 5 years,poor cognitive degree of anticoagulation and poor compliance of anticoagulation therapy are the main influencing factors of warfarin anticoagulation induced bleeding complications after mechanical valve replacement.