临床药师参与瓣膜置换术后华法林抗凝管理的病例对照研究  

Anticoagulation management in patients with mechanical heart valve replacement: A case control study

作　　者：林美钦[1] 邱罕凡[2] 谢先标[2] 陈美莲[2] 宋洪涛[1] 

机构地区：[1]福州总医院药学科,福州350025 [2]福建医科大学附属协和医院心脏外科,福州350001

出　　处：《中国胸心血管外科临床杂志》2017年第4期285-289,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的探讨临床药师在华法林抗凝治疗中的作用。方法纳入2013年3~10月在福建省协和医院心脏外科行人工机械瓣膜置换术后长期服用华法林的患者134例,其中男51例、女83例,平均年龄(49.8±10.4)岁,按纳入先后顺序交叉分为药师干预组及非干预组,每组各67例。比较抗凝初期两组患者抗凝效果及不良反应发生情况的差异。结果干预组与非干预组患者一般情况差异无统计学意义。两组患者首次达到目标国际标准化比值(INR)的时间[(7.1±3.3)d vs.(10.5±5.0)d,P=0.000]、住院期间INR在目标范围内(46.3%±18.8%vs.19.0%±16.2%,P=0.000)、抗凝不足(47.5%±19.5%vs.71.2%±22.9%,P=0.000)及抗凝过量的时间比例(5.3%±8.2%vs.9.9%±16.7%,P=0.002)差异有统计学意义,而术后住院时间差异无统计学意义[(19.9±6.6)d vs.(18.1±7.0)d,P=0.137]。干预组轻度出血4例(6.0%),无严重并发症。非干预组患者7例(10.4%)轻度出血,2例患者在术后并发脑卒中,1例并发轻度肺栓塞,严重并发症发生率为4.5%。结论临床药师参与心脏机械瓣膜置换术后华法林的抗凝治疗,可有效缩短患者首次达到治疗窗的时间,提高住院期间患者INR的达标率,降低患者发生血栓和出血的风险。Objective To investigate the role of clinical pharmacists in warfarin therapy. Methods A total of134 patients underwent prosthetic heart valve replacement and had warfarin for life from March 2013 to October 2013 in Fujian Medical University Union Hospital. All patients were equally divided into two groups（an intervention and a nonintervention group） crosswise by sequence. There were 67 patients in each group. The anticoagulant effects of the two groups were compared. Results There was no statistical difference in the patients＇ demographic information between the two groups. However, the time for the patients to reach the target international normalized ratio（INR） values for the first time（7.1±3.3 d vs. 10.5±5.0 d, P=0.000） and time of INR in the therapy range（46.3%±18.8% vs.19.0%±16.2%, P=0.000）during their hospitalization, proportion of time of under anticoagulation（47.5%±19.5% vs. 71.2%±22.9%, P=0.000）,proportion of time of anticoagulation overdose（5.3%±8.2% vs. 9.9%±16.7%, P=0.002） were significantly different. While there was no statistical difference in postoperative hospitalization time between the two groups（19.9±6.6 d vs. 18.1±7.0 d,P=0.137）. There were 4 patients（6.0%） with minor hemorrhage and no severe complication was found in the intervention group. There were seven patients（10.4%） with mild hemorrhage, two patients with stroke, one patient with mild pulmonary embolism, and severe complication rate of 4.5% in the non-intervention group. Conclusion With clinical pharmacists involved in the whole anticoagulation therapy progress of patients after mechanical heart valve replacement,the time to achieve the therapeutic window for the first time is effectively shorten, and the time of the INR value controlled in therapeutic range is highly improved during hospitalization time. Moreover, the patients＇ risk of thrombosis and bleeding is eventually reduced.

关 键 词：华法林 心脏机械瓣膜置换术 抗凝管理 临床药师 

分 类 号：R654.2[医药卫生—外科学]