“患者自我管理本”在机械瓣膜置换术后患者中的应用

Application of “patient self-management ” in patients with mechanical valve replacement

目的探讨心脏机械瓣膜置换术后患者应用"患者自我管理本"在抗凝治疗中的效果。方法选取2013年4—9月于上海交通大学医学院附属仁济医院行机械瓣膜置换术的患者127例,随机分为观察组60例和对照组67例,对照组采取常规记录和指导,观察组在对照组基础上加用"患者自我管理本";两组患者出院前1 d填写机械瓣膜置换术后知识问卷,出院6个月复诊时,采用修订版Morisky服药依从性量表测量服药依从性;出院1周后至出院1年后复诊,统计期间国际标准化比率(international normalized ratio,INR)变化情况。结果观察组抗凝知识掌握情况优于对照组,观察组口服华法林依从性高于对照组,观察组INR值控制情况优于对照组,差异均有统计学意义(P<0.05)。结论心脏机械瓣膜置换术后患者应用"患者自我管理本",有利于掌握抗凝知识,提高口服华法林依从性,控制INR值在正常范围;有助于医护人员掌握患者抗凝治疗情况。

Objective To investigate the application effect of ＂ patient self-management＂ in anticoagulation therapy of the patients with mechanical valve replacement. Methods From April to September 2013, 127 patients with mechanical valve replacement in Renji Hospital, Shanghai Jiao Tong University School of Medicine were selected. They were randomly divided into the experimental group （ n = 60） and control group （ n = 67 ）. The control group received the routine records and guidance, and the experimental group received additional ＂patient self-management＂. All the patients filled in the questionnaire 1 d before discharge. Six months after discharge, the revised version of Morisky Medication Adherence Scale was used to assess the patient medication compliance. During one week and one year after discharge the patients were followed up to analyze the changes in international normalized ratio （INR）. Results There were significant differences in the mastering of anticoagulation knowledge, compliance of oral administration of warfarin and control of INR values between the two groups （ P 〈 0.05 ）. Conclusion The application of ＂ patient self-management＂ in the patients with mechanical valve replacement is beneficial for the mastering of anticoagulation knowledge, improving the complicance of oral administration of warfarin and control of INR values, and could help medical staff to understand the dynamic situation of anticoagulation.