抗凝管理服务在心房颤动导管消融术后患者中的应用评价  

Evaluation of anticoagulation management service in patients who underwent catheter ablation for atrial fibrillation

作　　者：田颖[1] 齐淑媛[1] 卢晓英[1] 陈汝明[1] 尹先东[1] 周旭[1] 石亮[1] 王彦江[1] 杨新春[1] 刘兴鹏[1] 

机构地区：[1]首都医科大学附属北京朝阳医院心脏中心,100020

出　　处：《中华心律失常学杂志》2012年第5期330-333,共4页Chinese Journal of Cardiac Arrhythmias

基　　金：基金项目：国家自然基金（青年基金,81100125）;国家自然基金面上项目（31070754）

摘　　要：目的评价抗凝管理服务（AMS）在心房颤动（房颤）导管消融术后患者中的应用价值。方法连续245例[男134例，年龄（64±11）岁]接受导管消融治疗的房颤患者，所有患者术后均接受口服华法林抗凝治疗3—6个月。其中，前116例随机就诊于心内科门诊并接受华法林剂量调整（非AMS组），后129例接受经过培训的专业护士指导下的华法林剂量调整（AMS组）。比较两组的国际标准化比值（INR）达标率（INR值位于2．0～3．0之间）、有效抗凝率（≥70％的INR测定值达标）及INR波动指数（达标后的最大INR值-达标后最小INR值-1）。结果AMS组的INR达标率（92．2％）和有效抗凝率（59．8％）均显著高于非AMS组（分别为80．2％和42．7％，P值分别为0．008和0．027）。AMS组的INR波动指数0．64±0．74显著小于非AMS组（1．01±1．03，P=0．004）。结论在房颤导管消融术后应用华法林抗凝治疗的患者中系统应用AMS有助于提高抗凝治疗的达标率和有效抗凝率，并减小INR值的波动性。Objective To evaluate the effectiveness of anticoagulation management service （AMS） in patients who underwent catheter ablation for atrial fibrillation （AF）. Methods Two hundreds and forty-five consecutive patients [ 134 males; age （64 ± 11 ） years） with AF were enrolled. All patients received warfarin therapy for 3 -6 months after catheter ablation for AF. Patients adjusted their warfarin doses either by visiting the outpatient clinic （the former 116 patients, non-AMS group） or under the guidance of one well-trained nurse （the latter 129 patients, AMS group）. The percentage of patients in whom the international normalized ratio （INR） value achieved therapeutic anticoagulation range （2. 0 -3.0 ）, the effective anticoagulation rate that defined as more than 70% of INR values were between 2.0 - 3.0 after titration period, and the INR fluctuation index after titration period were compared between the 2 groups. Results Warfarin therapy rendered 119 patients （92. 2% ） in AMS group and 93 patients （80. 2% ） in non-AMS group achieved therapeutic anticoagulation range （P = 0. 008 ）. The effective anticoagulation rate in AMS group （59. 8% ） was significantly higher than that in non-AMS group （42. 7% ,P=0. 027） ,while the INR fluctuation index in AMS group were significantly less than that in non-AMS group（0.64±0.74 vs 1.01±1.03,P=0.004）.Conclusion This study demonstrates that the application of AMS in patients who underwent catheter ablation of AF is helpful in achieving higher effective antieoagulation rate while keeping therapeutic INR value more stable.

关 键 词：抗凝管理服务 心房颤动 射频导管消融 国际标准化比值 

分 类 号：R654.2[医药卫生—外科学]