房颤患者华法林自我管理现状及影响因素调查

Study on self-management of warfarin therapy in patients with atrial fibrillation: the influencing factors

目的了解房颤患者华法林自我管理现状,并探讨其影响因素,为房颤患者华法林自我管理干预措施的制定提供依据。方法便利抽取221例在心内科门诊就诊的口服华法林抗凝治疗的房颤患者,采用疾病感知问卷、服药信念量表与房颤患者口服华法林自我管理量表进行调查。结果房颤患者口服华法林自我管理总分为(31.93±5.51)分,疾病感知总分为(52.56±9.63)分,服药信念总分中位数为0.50分;不同居住方式、服药种数以及有无出血史患者口服华法林自我管理评分比较,差异有统计学意义(P<0.05,P<0.01)。房颤患者口服华法林自我管理总分与疾病感知总分、服药必要信念呈正相关(均P<0.05),与服药顾虑信念呈负相关(P<0.05)。多元逐步回归分析结果显示,疾病感知总分、服药必要信念与服药顾虑信念是房颤患者口服华法林自我管理的主要预测变量(调整R2=0.882)。结论护理人员应关注房颤患者口服华法林自我管理水平,采取措施提高患者疾病感知水平,树立积极的服药信念,以提高患者口服华法林自我管理能力。

Objective To understand the status quo of self-management of warfarin therapy in patients with atrial fibrillation,to explore the influencing factors,and to provide references for intervention measures for improvement of warfarin therapy self-management in the patients.Methods Totally,221 patients with atrial fibrillation treated with oral warfarin anticoagulant therapy in the outpatient department of cardiology were selected and investigated with the Brief Illness Perception Questionnaire,the Beliefs about Medicines Questionnaire and Oral Warfarin Self-management Scale.Results Patients with atrial fibrillation scored(31.93±5.51)points in warfarin therapy self-management,(52.56±9.63)points in disease perception,and a median of 0.50 points in medication belief.Warfarin therapy self-management scores had significant differences among patients living alone or not,taking various numbers of drugs,and having bleeding history or not(P<0.05,P<0.01).Warfarin therapy self-management was positively correlated with illness perception and medication necessity belief,while negatively correlated with medication concerns belief(P<0.05 for all).Multiple linear regression analysis showed that,illness perception,medication necessity belief,and medication concerns belief were major predictors of warfarin therapy self-management(adjusted R 2=0.882).Conclusion Nursing staff should pay attention to self-management level of warfarin therapy in patients with atrial fibrillation,take active measures to improve patients' di-sease perception level,and help them foster positive medication belief,so as to improve patients' self-management ability of oral warfarin therapy.