临床药师指导下非瓣膜病房颤患者应用华法林抗凝治疗的疗效分析

Clinical Effectiveness Analysis of Warfarin Anticoagulation Therapy in Patients with non Valvular Atrial Fibrillation Guided by Clinical Pharmacists

目的:分析临床药师指导下非瓣膜病房颤患者应用华法林抗凝治疗的疗效。方法:选择我院2014年1月至2017年6月收治非瓣膜病房颤患者91例,按治疗方式不同分为对照组(47例)和研究组(44例)。对照组予以传统华法林用药,研究组于临床药师指导下予以华法林用药。比较两组治疗依从性,国际标准化比值(INR)达标率,内皮功能,纤溶指标,及不良反应发生情况。结果:治疗后,研究组治疗依从性优于对照组,比较有统计学差异(P<0.05)。研究组INR达标率高于对照组(P<0.05)。治疗前,两组内皮素-1(ET-1)、循环内皮细胞(CEC)比较无差异(P>0.05),治疗后,两组上述指标均下降,研究组低于对照组,比较有统计学差异(P<0.05)。研究组纤溶酶原激活物抑制剂-1(PAI-1)、组织型纤溶酶原激活物(t-PA)及D-二聚体(D-D)低于对照组(P<0.05)。研究组并发症发生率低于对照组(P<0.05)。结论:非瓣膜病房颤患者应用临床药师指导华法林抗凝治疗能够改变患者认知和行为状态,提高其治疗依从性及INR达标率,降低华法林抗凝的风险性。

Objective： To analyze the efficacy of warfarin anticoagulation therapy in patients with non valvular atrial fibrillation under the guidance of clinical pharmacists. Methods： 91 patients with non-valvular atrial fibrillation who received therapy from January 2014 to June 2017 in our hospital,according to different treatment methods. All the patients were divided into 47 control groups and 44 research groups. The control group was treated with traditional warfarin,and the research group was given warfarin under the guidance of clinical pharmacist. then treatment compliance,international standardized ratio（INR）,endothelial function,fibrinolytic index,and adverse reactions between two group was compared. Results： After treatment,the therapeutic compliance in the research group was better than that of the control group,with statistically significant difference（P 0.05）. the INR compliance rate in research group was higher than the control group（P 0.05）.Before treatment,the endothelin 1（ET-1）,circulating endothelial cells（CEC） in two group was no difference（P 0.05）,after treatment,the above indicators in research group was lower than the control group,with statistically significant difference（P 0.05）. plasminogen activator inhibitor-1（PAI-1）,tissue plasminogen activator（t-PA） and D-dimer（D-D） in research group were lower than the control group（P 0.05）. Complication rate in research group was lower than that in the control group（P 0.05）. Conclusion： Non-valvular AF patients with clinical pharmacist guidance warfarin anticoagulant therapy can change the patient＇s cognitive and behavioral status,improve their treatment compliance and INR compliance rate,reduce the risk of warfarin anticoagulation.