基于护士主导的集束化抗凝管理在华法林抗凝治疗房颤患者中的应用价值

Application value of nurse-led cluster anticoagulation management in patients with atrial fibrillation treated with warfarin anticoagulation

目的:探讨基于护士主导的集束化抗凝管理模式对房颤患者华法林抗凝治疗国际标准化比值(International normalized ratio,INR)达标率及血液流变学水平的影响。方法:选取我科2021年3月至2022年9月期间112例房颤拟服用或正在服用华法林的患者作为研究对象,按随机数字法分为两组,常规组56例用药期间行常规护理指导,抗凝组56例给予护士主导的集束化抗凝管理模式,对两组患者进行为期3 m的干预,采集静脉血对比抗凝效果和血液流变学指标,通过调查问卷对比自我管理能力,统计并记录干预期间并发症发生率。结果:抗凝组INR达标率低于常规组,TTR值高于常规组(P<0.05);干预前,两组成年人健康自我管理能力测评量表(Adult health self-management ability assessment scale,AHSMSRS)各维度评分及总分对比无差异(P>0.05),干预3 m后,两组AHSMSRS各维度评分均升高,且抗凝组高于常规组(P<0.05);干预前,两组D-二聚体(D-Dimer,D-D)、全血黏度(Whole blood viscosity,NB)、纤维蛋白原(Fibrinogen,FIB)、纤维蛋白原降解物(Fibrinogen degradation product,FDP)水平对比无差异(P>0.05),干预3 m后,两组D-D、NB、FIB、FDP水平均降低,且抗凝组低于常规组(P<0.05);抗凝组抗凝并发症发生率低于常规组(P<0.05)。结论:基于护士主导的集束化抗凝管理模式应用于房颤患者华法林抗凝治疗有助于增强抗凝效果,改善血液流变学,增强自我管理能力,降低抗凝并发症发生率。

Objective:To investigate the effect of nurse-led bunch-based anticoagulation management mode on the standard INR compliance rate and hemorheology level of warfarin anticoagulation therapy in patients with atrial fibrillation.Methods:112 patients with atrial fibrillation who planned to take warfarin or were taking warfarin in our department from March 2021 to September 2022 were selected as the research objects,and were randomly divided into two groups.56 patients in the routine group were given routine nursing guidance during medication,and 56 patients in the anticoagulation group were given cluster anticoagulation management mode led by nurses.The venous blood of the two groups was collected for three months to compare the anticoagulation effect and hemorheology indexes,and the self-management ability was compared through questionnaires.The incidence of complications during the intervention period was counted and recorded.Results:The INR compliance rate in anticoagulation group was lower than that in routine group,and the TTR value was higher than that in routine group(P<0.05).Before the intervention,the two groups were adults.Results:The standard rate of INR in anticoagulation group was lower than that in routine group,and the TTR value was higher than that in routine group(P<0.05).Before the intervention,there was no difference in the scores of each dimension and the total score of the Adult Health SelfManageability Assessment Scale(AHSMRS)between the two groups(P>0.05).After three months of intervention,the scores of AHSMRS in both groups increased,and the anticoagulation group was higher than the routine group(P<0.05).Before the intervention,there was no difference in the levels of D-dimer(D-D),Whole blood viscosity(NB),Fibrinogen(FIB)and fibrinogen degradation product(FDP)between the two groups(P>0.05).The incidence of anticoagulation complications in anticoagulation group was lower than that in routine group(P<0.05).Conclusion:The application of nurse-led cluster anticoagulation management model in warfarin anticoagulation therapy for patients with atrial fibrillation is helpful to enhance anticoagulation effect,improve hemorheology,enhance self-management ability and reduce the incidence of anticoagulation complications.