微信平台管理对心脏机械瓣膜置换术后抗凝治疗的随机对照研究

潘巧玲; 朱秀英; 茹媛慧; 章培; 石活顺; 李旎; 徐国栋

doi:10.16766/j.cnki.issn.1674-4152.001939

微信平台管理对心脏机械瓣膜置换术后抗凝治疗的随机对照研究

doi: 10.16766/j.cnki.issn.1674-4152.001939

1.
宁波市医疗中心李惠利医院护理部，浙江宁波 315211
2.
宁波市医疗中心李惠利医院心胸外科，浙江宁波 315211

基金项目:

浙江省基础公益研究计划项目 LGD20H020001

详细信息

通讯作者:
潘巧玲，E-mail：542686844@qq.com

中图分类号: R473.54 R654.2
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- 被引次数: 0
出版历程
- 收稿日期: 2020-02-24
- 网络出版日期: 2022-02-16

A randomised controlled trial of warfarin anticoagulation after mechanical heart valve replacement via WeChat platform management

1.
Nursing Department, Ningbo Medical Centre Lihuili Hospital, Ningbo, Zhejiang 315211, China

摘要

摘要: 目的通过前瞻性、随机、单中心研究比较微信平台管理与常规术后管理对于心脏机械瓣膜置换术后应用华法林抗凝治疗的疗效和并发症。方法根据入选标准将宁波市医疗中心李惠利医院心脏机械瓣膜置换术后患者按出院时间排序，奇数组设为观察组(微信平台管理组，153例)，偶数组设为对照组(常规术后管理组，144例)。对照组进行常规术后护理指导，观察组应用微信平台实施延续性护理干预。通过定期门诊随访，调整患者华法林剂量并记录2组患者的一般情况和并发症发生情况。主要终点事件为INR达标率，次要终点事件包括任何原因导致的死亡、栓塞事件、出血事件、抗凝相关急诊就诊次数。结果共297例患者入组，2组患者在年龄、性别、手术方式等一般资料比较差异均无统计学意义。与对照组比较，观察组明显提高了国际标准化比值(INR)的达标率(75.48% vs. 59.38%, P < 0.001)。而2组在严重出血事件(1.31% vs. 2.78%, P=0.368)、血栓栓塞事件(1.31% vs. 0.69%, P=0.598)和任何原因导致的死亡事件(0.65% vs. 1.39%，P=0.527)方面比较差异无统计学意义；观察组轻度出血事件发生率(17.6% vs. 30.6%, P=0.023)和抗凝相关急诊就诊次数[0.86(0.00, 1.00)次vs. 1.36(1.00, 2.00)次，P=0.031]低于对照组。结论与常规术后管理相比，通过微信平台管理可明显提高华法林抗凝治疗的INR达标率，降低轻度出血事件的发生率，减少抗凝相关急诊就诊次数。
- 微信 /
- 心脏机械瓣膜置换术 /
- 华法林 /
- 抗凝治疗
Abstract: Objective A prospective, randomised, single-centre study was conducted to compare the efficacy and complications of warfarin anticoagulation in patients undergoing mechanical heart valve replacement postoperative management of patients was performed via WeChat platform or conventional methods. Methods According to the inclusion criteria, the patients in our hospital after undergoing mechanical valve replacement were randomly assigned to an experimental group (WeChat platform management group) and a control group (traditional management group). The control group received routine postoperative nursing guidance, whereas the experimental group received continuous nursing intervention via WeChat platform. Through regular outpatient follow-up, warfarin dosage was adjusted, and the general situation and complications of the two groups were recorded. The primary end point was international normalised ratio (INR) compliance rate, whereas the secondary end point included death, thromboembolism, bleeding and the number of, and anticoagulation-related emergency department visits. Results A total of 297 patients were enrolled in this study. No significant difference was observed between the two groups in terms of baseline characteristics, including gender, age and type of surgery. Compared with the control group, the experimental group had significantly improved INR compliance rate (75.48% vs. 59.38%, respectively; P < 0.001). No significant difference was found between the two groups in terms of major bleeding events (1.31% vs. 2.78%, respectively; P=0.368), thromboembolism events (1.31% vs. 0.69%, respectively; P=0.598) and deaths from any cause (0.65% vs. 1.39%, respectively; P=0.527). However, the incidence of mild bleeding events (17.6% vs. 30.6%, respectively; P=0.023) and the number of anticoagulation-related emergency department visits [0.86(0.00, 1.00) vs. 1.36(1.00, 2.00), respectively; P=0.031] in the experimental group were lower than those in the control group. Conclusion Compared with routine postoperative management, the application of WeChat platform to manage anticoagulation treatment of the patients after mechanical heart valve replacement can improve the INR compliance rate, reduced the incidence of mild bleeding events and the number of, anticoagulation-related emergency department visits.
- WeChat /
- Mechanical heart valve replacement /
- Warfarin /
- Anticoagulation

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图 1 患者分组及随访研究流程图

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表 1 2组心脏机械瓣膜置换术患者术前一般资料比较(例)

组别	例数	年龄(x±s, 岁)	性别(男/女)	手术方式			同期行		合并症
组别	例数	年龄(x±s, 岁)	性别(男/女)	MVR	AVR	DVR	TVP	高血压	糖尿病	脑卒中史	消化道溃疡史	房颤
观察组	153	50.42±10.37	77/67	61	33	59	20	33	13	13	12	43
对照组	144	49.77±10.80	76/77	63	29	52	26	24	12	16	8	47
统计量		0.532^a	0.429^b	0.459^b			1.408^b	1.149^b	0.003^b	0.575^b	0.618^b	0.722^b
P值		0.606	0.513	0.795			0.235	0.284	0.960	0.448	0.432	0.395
注：^a为t值，^b为χ²值。MVR为二尖瓣置换术，AVR为主动脉瓣置换术，DVR为双瓣置换术，TVP为三尖瓣成形术。

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表 2 2组心脏机械瓣膜置换术患者随访结果比较

组别	例数	INR达标率(%)	抗凝相关并发症[例(%)]				抗凝相关急诊就诊次数[M(P₂₅, P₇₅)，次]
组别	例数	INR达标率(%)	严重出血事件	轻度出血事件	血栓栓塞事件	任何原因导致的死亡	抗凝相关急诊就诊次数[M(P₂₅, P₇₅)，次]
观察组	153	75.48	2(1.31)	27(17.6)	2(1.31)	1(0.65)	0.86(0.00, 1.00)
对照组	144	59.38	4(2.78)	44(30.6)	1(0.69)	2(1.39)	1.36(1.00，2.00)
统计量		14.580^a	0.810^a	7.582^a	0.279^a	0.401^a	-1.612^b
P值		< 0.001	0.368	0.023	0.598	0.527	< 0.001
注：^a为χ²值，^b为Z值。

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