心脏机械瓣膜置换术后患者华法林抗凝治疗并发症及其影响因素

An investigation into the complications of warfarin anticoagulant therapy and its influencing factors in patients with cardiac mechanical valve replacement

目的:了解机械瓣膜置换术后患者华法林相关并发症的相关影响因素。方法:选取2012年1月至12月在宁波市医疗中心李惠利医院行机械瓣膜置换的患者为研究对象,通过电话随访结合门诊随访情况,记录患者一般情况、抗凝情况、凝血功能等指标。对于分类变量采用χ2检验,多因素分析采用logistic回归模型。结果:抗凝药物依从性及房颤在有、无抗凝并发症2组间差异有统计学意义(P<0.05),瓣膜置换类型、年龄、文化程度、脑梗史、烟酒史、其他长期药物史在2组间差异无统计学意义(P>0.05)。多因素logistic回归显示房颤及抗凝药物依从性与抗凝并发症显著相关,OR值分别为2.570、4.628。结论:抗凝药物依从性差及房颤是机械瓣膜术后发作抗凝并发症的独立危险因素。

Objective:To investigate the influencing factors of warfarin-related complications in mechanical valve patients,so as to understand the factors that may influence patients'anticoagulation compliance.Methods:Patients who had mechanical valve replacement in Ningbo Medical Treatment Centre of Lihuili Hospital from January to December 2012 were enrolled in this investigation.The questionnaire,which included general information of patients,anticoagulant condition,coagulation function and other indicators,was completed by all subjects mainly via telephone visits and outpatient follow-up.Chi-square test was used for categorical variables,and logistic regression model for multivariate analysis.Results:There was statistical difference in anticoagulant compliance and atrial fibrillation(AF)between two groups of anticoagulation complications(P<0.05),while there’s no significant difference between the two groups in the type of valve replacement,patient’s age,education,history of cerebral infarction,history of tobacco and alcohol and other long-term drug history(P>0.05).Multivariate logistic regression showed that AF and anticoagulation compliance were significantly associated with anticoagulant complications,with OR values being 2.570 and 4.628 respectively.Conclusion:Poor compliance with administration of warfarin and atrial fibrillation are independent risk factors for anticoagulation complications after mechanical valve replacement.