“四位一体”管理模式在社区老年慢性非瓣膜性房颤患者抗凝治疗中的应用

The application of“four in one”integrated management mode in the anti-coagulation of community elder non-valvular atrial fibrillation patients

目的:探讨综合管理模式对老年慢性非瓣膜性房颤患者的干预疗效。方法:选取2018年2月1日至2018年8月1日上海市闵行区梅陇社区卫生服务中心登记治疗的老年慢性非瓣膜性房颤患者100例。采用随机函数法分为2组,研究组(50例)采用社区“四位一体”的房颤综合管理模式,对照组(50例)采用社区常规房颤管理模式,研究终点为出现中风事件或内脏出血事件,随访至2020年2月1日。比较2组患者依从性,血管栓塞事件发生率和出血事件发生率。结果:研究组和对照组的基线临床变量差异无统计学意义。干预后,研究组较对照组服药依从性和复诊依从性显著性提高(P<0.001),研究组较对照组血管栓塞事件下降75%(OR=0.25,P<0.001),出血事件下降62%(OR=0.38,P<0.001)。结论:社区“四位一体”的综合管理模式对老年慢性非瓣膜性房颤患者的疗效优异,患者的依从性明显提高,中风发生率明显下降。

Objective:To explore the integrated management mode(IMM)in the treatment of non-valvular atrial fibrillation(NVAF).Methods:From February 1,to August 1,2018,100 qualified NVAF patients who registered in the MeiLong Community Health Center,was recruited and randomly assigned into two groups,the IMM group and the control group.For the control group,routine community intervention was deployed;for the IMM group,the integrated management mode was deployed.The end point of the research was stroke or visceral hemorrhage,with a follow-up to February 1,2020.Results:It was found that there was no significant difference between the IMM and the control group regarding clinical variables.The medicine obedience of the IMM group was significantly higher than that of the control group(P<0.001),and the incidence of thrombotic events and hemorrhagic was significantly lower(OR=0.25,P<0.001 and OR=0.38,P<0.001 respectively).Conclusions:The“four in one”IMM in the community has superior effect on the CAF patient.The medical obedience of the patients is significantly improved,and the incidence of stroke is significantly decreased.