不同国际标准化比值区间的华法林在老年房颤患者中的应用效果比较

Comparison of the application effect of Warfarin with different international normalized ratio intervals in elderly patients with atrial fibrillation

目的:探讨不同的国际标准化比值(INR)区间的华法林在老年房颤患者中的应用效果。方法:选取2019年3月—2021年3月上海市长宁区天山中医医院收治的120例老年非瓣膜病房颤患者,采用随机数字表法分为对照组与研究组各60例。对照组INR维持在1.6~2.0,研究组INR维持在2.1~2.6,根据INR值调整华法林剂量。随访12个月,对比两组临床疗效、内生肌酐清除率、治疗前后24h心室率变化及不良反应发生率。结果:研究组治疗总有效率(96.67%)高于对照组(76.67%),差异有统计学意义(P<0.05)。治疗前,两组肌酐清除率比较,差异无统计学意义(P>0.05);治疗6、9、12个月,研究组的肌酐清除率均较服药前略有上升,对照组肌酐清除率较服药前下降,两组间比较,差异有统计学意义(P<0.05)。治疗前,两组24h心室率比较,差异无统计学意义(P>0.05);治疗后,研究组24h心室率低于对照组,差异有统计学意义(P<0.05)。对照组出血事件总发生率为13.33%,研究组出血事件总发生率为20.00%,两组比较,差异无统计学意义(P>0.05);研究组不良事件总发生率(3.33%)低于对照组(46.67%),差异有统计学意义(P<0.05)。结论:相较于INR维持在1.6~2.0,INR控制在2.1~2.6时华法林在预防老年人非瓣膜性房颤患者中的应用效果更佳,能够降低临床不良事件的发生率,进一步改善患者肾功能,降低心室率,值得临床应用。

Objective To investigate the effect of Warfarin with different international normalized ratio(INR)intervals in elderly patients with atrial fibrillation.Methods From March 2019 to March 2021,120 elderly patients with non-valvular atrial fibrillation who were admitted to Tianshan Hospital of Traditional Chinese Medicine in Changning District,Shanghai were selected as the research objects,and divided into the control group and the research group with 60 cases in each group by random number table method.The INR of the control group was maintained at 1.6~2.0,and the INR of the study group was maintained at 2.1~2.6,and the Warfarin dose was adjusted according to the INR value.During the 12-month follow-up,the clinical efficacy,endogenous creatinine clearance rate,24-h ventricular rate changes before and after treatment and the incidence of adverse reactions were compared between the two groups.Results The total effective rate of the study group(96.67%)was higher than that of the control group(76.67%),with a statistically significant difference(P<0.05).Before treatment,there was no significant difference in creatinine clearance between the two groups(P>0.05);After 6,9 and 12 months of treatment,the creatinine clearance rate in the study group increased slightly compared with that before administration,while that in the control group decreased.The difference between the two groups was statistically significant(P<0.05).Before treatment,there was no significant difference between the two groups in 24h ventricular rate(P>0.05);After treatment,the 24h ventricular rate in the study group was lower than that in the control group,with a statistically significant difference(P<0.05).The total incidence of bleeding events was 13.33%in the control group and 20.00%in the study group.There was no significant difference between the two groups(P>0.05);The total incidence of adverse events in the study group(3.33%)was lower than that in the control group(46.67%),with a statistically significant difference(P<0.05).Conclusion Compared with the INR maintained at 1.6~2.0,the application effect of Warfarin in the prevention of elderly patients with non-valvular atrial fibrillation is better when the INR is controlled at 2.1~2.6,which can reduce the incidence of adverse events such as clinical embolism.To further improve the renal function of patients and reduce the ventricular rate,it is worthy of clinical application.