心脏瓣膜置换术后规范化抗凝治疗的临床实践  

Pharmacy Practice for Standardized Anticoagulant Therapy After Heart Valve Replacement in Pharmacist Anticoagulation Outpatient

作　　者：贝宇飞[1] 陈新明[2] 张群[2] 张春燕[1] 吉顺莉[1] 王莉[3] 郎智慧 BEI Yufei;CHEN Xinming;ZHANG Qun;ZHANG Chunyan;JI Shunli;WANG Li;LANG Zhihui(Department of Pharmacy,Affiliated Hospital of Nantong University,Nantong Jiangsu 226000,China;Department of Cardiothoracic Surgery,Affiliated Hospital of Nantong University,Nantong Jiangsu 226000,China;Department of Pharmacy,the Fifth Affiliated Hospital of Guangzhou Medical University,Guangzhou Guangdong 510000,China;Department of Pharmacy,Shenzhen Hospital,Peking University,Shenzhen Guangdong 518000,China)

机构地区：[1]南通大学附属医院药学部,江苏南通226000 [2]南通大学附属医院心胸外科,江苏南通226000 [3]广州医科大学附属第五医院药学部,广东广州510000 [4]北京大学深圳医院药学部,广东深圳518000

出　　处：《中国继续医学教育》2021年第32期117-120,共4页China Continuing Medical Education

基　　金：2019年度南通市卫生健康委药物政策科研项目(YAOZ201910);南通市市级科技计划(指导性)项目(JCZ20117);南通市药学会-常州四药医院药学基金科研项目(ntyx2018)。

摘　　要：目的探讨临床药师参与心脏瓣膜置换术后患者的抗凝治疗管理的临床实践。方法采用目的抽样法,抽取2018年6月—2019年6月在本院就诊的心脏瓣膜置换术患者86例,按照随机数字表发分为对照组和观察组,每组各43例,对照组进行常规抗凝治疗,观察组由抗凝门诊临床药师进行抗凝干预治疗,包括建立患者个人信息档案、进行抗凝诊疗指导、定期随访等,采用抗凝知识调查问卷评估患者对抗凝治疗的认知度,采用抗凝治疗依从性调查问卷评估患者的用药依从性,对比患者治疗期间就诊报告以评估不良反应发生率。结果两组患者对抗凝治疗的认知评价得分情况显示,治疗后,两组相对于治疗前均明显改善(P<0.05)。治疗前组间比较差异无统计学意义(P>0.05),治疗后组间比较,观察组更优,且差异有统计学意义(P<0.05);两组患者范化抗凝治疗前后用药依从性比较,6个月及12个月时,相对于对照组,观察组均明显更优,且差异有统计学意义(P<0.05);随访1年,观察组并发症发生率为2.33%,明显低于对照组18.60%(P<0.05)。结论药师指导的规范化抗凝治疗有助于提高心脏瓣膜置换术患者抗凝认知度、用药依从性,减少并发症的发生,可改善患者抗凝治疗的质量。Objective To explore the clinical practice of pharmacists involved in the management of anticoagulation therapy for patients after heart valve replacement.Methods A total of 86 patients with heart valve replacement who were treated in our hospital from June 2018 to June 2019 were included as study subjects.The patients were divided into control group and observation group,43 cases in each group.The control group received routine anticoagulation treatment,while the observation group received anticoagulation intervention treatment by clinical pharmacists in the anticoagulation clinic,including the establishment of patients'personal information files,anticoagulation diagnosis and treatment guidance,regular follow-up,etc.The anticoagulation knowledge questionnaire was used to evaluate the patients'awareness of anticoagulation therapy,and the medication compliance questionnaire was used to evaluate the patients'medication compliance.The incidence of adverse reactions was assessed by comparing patients'reports of visits during treatment.Results The cognitive evaluation scores of anticoagulant therapy in the two groups showed that after treatment,the two groups were significantly improved compared with those before treatment(P<0.05).There was no significant difference between the groups before treatment(P>0.05).After treatment,the observation group was better,and the difference was statistically significant(P<0.05).Compared with the control group,the observation group was significantly better at 6 and 12 months,and the difference was statistically significant(P<0.05).The incidence of complications in the observation group was 2.33%,which was significantly lower than 18.60%in the control group(P<0.05).Conclusion The standardized anticoagulation therapy guided by pharmacists is helpful to improve the anticoagulation awareness,medication compliance,reduce the occurrence of complications,and improve the quality of anticoagulation therapy.

关 键 词：心脏瓣膜置换术 抗凝 治疗 认知度 依从性 并发症 

分 类 号：R541[医药卫生—心血管疾病]