专人随访管理在持续性心房颤动病人服用华法林抗凝治疗中的作用

摘要

Objective To evaluate the influence of fol ow up management with special messenger on the treatment of warfarin antico-agulation in patients with permanent atrial fibril ation.Methods One hundred and sixty patients with permanent atrial fibril ation were recruited and divided into the routine fol ow up visit group (control group)and special messenger fol ow up management group (manage group)randomly according to the registration order.Al patients were accepted fol ow up visit for 12 months.The interna-tional normalized ratio (INR),warfarin dose,the status of INR up to the standard and the complications of each patient were recor-ded.Results The average warfarin dose,the detection frequency after INR up to the standard for the first time and the detection fre-quency of INR in the whole course in the manage group patients were significantly lower than the control group(P<0.05)The day and the detection frequency of INR up to the standard for the first time,the average INR value were not different statistical y between the two groups (P>0.05).The status of INR up to the standard in the first month,the third month,the fourth month,the seventh month,the nineth month,the eleventh month and twelfth month were significantly different between the two groups during the 12 months fol ow up visit(P<0.01).The incidence of complications of ischemic stroke,other arterial embolism,mucocutaneous hemor-rhage,gingival hemorrhage,rhinorrhagia,haematuria and gastrointestinal hemorrhage in the manage group patients were significantly lower than the control group patients(P<0.05).Conclusion The fol ow up management with special messenger for the treatment of warfarin anticoagulation in patients with permanent atrial fibril ation could decrease the warfarin dose and the detection frequency of INR,improve the anticoagulant effect,reduce the complication of thromboembolism and hemorrhage.%目的：研究专人随访管理对持续性心房颤动(房颤)病人服用华法林抗凝效果的影响。方法随机选取160例持续性房颤病人，按就诊顺序编号分为管理组和对照组，各80例，分别接受专人随访管理和普通随访，记录12个月中各组病人的国际标准化比值(INR)，比较两组病人华法林服用剂量和华法林抗凝治疗的达标情况，并发症发生情况。结果管理组病人服用华法林平均剂量、INR首次达标后监测次数、INR全程监测频次明显少于对照组(P<0.05)，两组间 INR首次达标天数、INR达标所需监测次数、平均 INR值比较差异无统计学意义。连续随访12月期间，在第1月、第3月、第4月、第7月、第9月、第11月和第12月两组病人INR达标情况比较有统计学意义(P<0.01)。管理组病人缺血性卒中、皮肤黏膜出血、牙龈出血、鼻出血、血尿、消化道出血并发症的发生率显著低于对照组(P<0.05)，两组发生颅内出血和死亡的比较差异无统计学意义。结论对持续性房颤病人服用华法林专人负责的随访管理可以减少病人华法林服用剂量和 INR监测频次，提高华法林抗凝效果，降低血栓栓塞和出血并发症。