心脏瓣膜置换术后影响华法林抗凝达标的相关因素分析  

Analysis of Related Factors Affecting Warfarin Anticoagulation after Cardiac Valve Replacement

作　　者：罗赛赛 郑巧伟[1] 王陶陶[1] 高春侠 安梦娜 尤海生[1] 封卫毅[1] Luo Saisai;Zheng Qiaowei;Wang Taotao;Gao Chunxia;An Mengna;You Haisheng;Feng Weiyi(Department of Pharmacy,the First Affiliated Hospital of Xi'an Jiaotong University Medical College,Xi'an 710061,China)

机构地区：[1]西安交通大学第一附属医院药学部

出　　处：《药物流行病学杂志》2019年第8期507-510,共4页Chinese Journal of Pharmacoepidemiology

基　　金：陕西省自然科学研究计划项目(编号:2018JM7053);西安交通大学第一附属医院院基金项目(编号:2018MS-21)

摘　　要：目的:探讨心脏瓣膜置换术后使用华法林抗凝患者的国际标准化比值(INR)达标相关影响因素。方法:应用回顾性分析方法,随机抽取某三甲教学医院2018年1~12月瓣膜置换术后使用华法林患者病例资料100份,根据出院时INR值达标情况分为达标组与未达标组,采用单因素分析及二元Logistic回归模型,对INR达标情况及其影响因素进行分析。结果:INR值达标组39例,未达标组61例。Logistic回归分析结果显示,术后联用阿司匹林患者的INR值达标可能性低于未联用患者[OR=0.220,95%CI(0.063,0.772)],术后联用贝那普利患者较未联用患者的INR值更可能达标[OR=2.541,95%CI(1.026,6.295)],监测INR值次数>5较监测次数≤5的患者INR值更可能达标[OR=7.701,95%CI(2.037,29.112)]。结论:联用阿司匹林、联用贝那普利、监测INR值次数(>5)是影响心脏瓣膜置换术后华法林抗凝INR值达标的主要因素,应结合相关影响因素,为临床药师指导个体化使用华法林提供初步的参考依据。Objective:To discuss the influencing factors for reaching the target range of international normalized ratio(INR)in patients with warfarin after heart valve replacement.Methods:In retrospective study,100 patients with warfarin after valve replacement were extracted at random in a third eaching hospital from January to December 2018.According to the INR value,it was divided into the attainment group and the non-attainment group.Analysis of related factors by univariate analysis and binary logistic regression analysis.Results:There were 39 patients in the attainment group and 61 patients in the non-attainment group.Binary logistic regression analysis showed that,People given in combination with aspirin than non-combination aspirin had lower likely to reach the target range of INR(OR=0.220,95%CI 0.063 to 0.772),and people given in combination with benazepril than non-combined benazepril had more likely to reach the target range of INR(OR=2.541,95%CI 1.026 to 6.295),and people monitoredthe number of INR values>5 than the number≤5 had more likely to reach the target range of INR(OR=7.701,95%CI 2.037 to 29.112).Conclusion:Combined aspirin or benazepril,and monitor the number of INR values(>5)were the main affecting warfarin anticoagulation for reaching the target range of INR after cardiac valve replacement.It should provide a preliminary reference for clinical pharmacists to guide individualized use of warfarin.

关 键 词：华法林 心脏瓣膜置换术 国际标准化比值 影响因素 

分 类 号：R973.2[医药卫生—药品]