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  

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

作　　者：潘巧玲 朱秀英[1] 茹媛慧 章培 石活顺[2] 李旎 徐国栋[2] PAN Qiao-ling;ZHU Xiu-ying;RU Yuan-hui;ZHANG Pei;SHI Huo-shun;LI Ni;XU Guo-dong(Nursing Department,Ningbo Medical Centre Lihuili Hospital,Ningbo,Zhejiang 315211,China)

机构地区：[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

出　　处：《中华全科医学》2021年第5期875-879,共5页Chinese Journal of General Practice

基　　金：浙江省基础公益研究计划项目(LGD20H020001)。

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。Objective A prospective,randomised,single-centre study was conducted to compare the efficacy and com-plications 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 re-ceived 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)compli-ance rate,whereas the secondary end point included death,thromboembolism,bleeding and the number of,and antico-agulation-related emergency department visits.Results A total of 297 patients were enrolled in this study.No signifi-cant 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).Howev-er,the incidence of mild bleeding events(17.6%vs.30.6%,respectively;P=0.023)and the number of anticoagula-tion-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 man-agement,the application of WeChat platform to manage anticoag

关 键 词：微信 心脏机械瓣膜置换术 华法林 抗凝治疗 

分 类 号：R473.54[医药卫生—护理学] R654.2[医药卫生—临床医学]