“全程管理模式”在心脏瓣膜置换术后患者抗凝治疗中的应用观察

Application of"full management mode"in anticoagulation therapy for patients after cardiac valve re⁃placement

目的观察“全程管理模式”在心脏瓣膜置换术后患者抗凝治疗中的应用效果。方法选择心脏瓣膜置换术后患者208例为观察组,在抗凝治疗中采用多学科协作“一站式”抗凝门诊联合信息化随访平台的“全程管理模式”,进行覆盖“门诊+社区”的抗凝管理。另选择同期在普通门诊进行随访的208例心脏瓣膜置换术后患者为对照组。随访期间采用修订后的Morisky服药依从性量表评价两组患者华法林服药依从性,比较两组凝血酶原时间国际标准化比值(INR)及患者INR检测次数,采用治疗范围时间分数(FTTR)评价两组抗凝治疗质量,观察两组抗凝相关并发症的发生情况。结果观察组、对照组Morisky评分分别为6.75(1.50)、5.50(2.00)分,INR检测次数分别为9.00(12.75)、5.00(10.00)次,INR检测结果分别为1.96(0.65)、1.91(0.76),FTTR分别为49.64%、41.05%,二者比较,P均<0.05。观察组、对照组发生抗凝相关并发症分别为19、27例。结论“全程管理模式”用于心脏瓣膜置换术后患者抗凝管理的效果较好,能提高患者INR检测频次及华法林服药的依从性,提高患者抗凝质量。

Objective To observe the application effect of"full management mode"in anticoagulantion therapy for patients after cardiac valve replacement.Methods Totally 208 patients after cardiac valve replacement were selected as the observation group,and then the"full management mode"covering"outpatient clinic+community"was adopted in the anticoagulation management by multidisciplinary collaboration"one-stop"anticoagulation clinic combined with informa⁃tion follow-up platform.In addition,208 patients after cardiac valve replacement,followed up in the general outpatient de⁃partment,were selected as the control group.During the follow-up period,modified Morisky score was applied to evalu⁃ate medication compliance of warfarin in the two groups,while the results and detection times of prothrombin time and in⁃ternational normalized ratio(INR)were compared.Time in therapeutic range(FTTR)was used to evaluate the anticoag⁃ulation therapy in the two groups and the anticoagulation related complications were observed.Results Morisky scores of patients in the observation group and control group were 6.75(1.50)and 5.50(2.00)points,INR test numbers were 9.00(12.75)and 5.00(10.00),INR test results were 1.96(0.65)and 1.91(0.76),and FTTR were 49.64%and 41.05%,respectively,with statistically significant differences between these two groups(all P<0.05).There were 19 cases of anticoagulation related complications in the observation group and 27 cases in the control group.Conclusion"Full management mode",which can improve INR detection frequency and warfarin medication compliance of patients af⁃ter cardiac valve replacements,has good effect on anticoagulation management and improves anticoagulation quality of pa⁃tients.