126例肺栓塞患者华法林达标时间及出血事件分析  

Analysis of the Anticoagulant Efficacy of Warfarin and Related Bleeding Events in Patients with Pulmonary Embolism

作　　者：吴婷婷[1] 杨林[1] 宋晓波[2] 李晓烨 Wu Tingting;Yang Lin;Song Xianho;Li Xiaoye(Department of Respiratory Medicine,Shanghai Songjiang District Central Hospital,Shanghai 201600,China;Department of Respiratory and Critical Care Medicine,Songjiang District Central Hospital;Department of Respiratory Medicine,Zliongshan Hospital,F'udan University)

机构地区：[1]上海市松江区中心医院药剂科,上海201600 [2]上海市松江区中心医院呼吸与危重病学科 [3]复旦大学附属中山医院药剂科

出　　处：《药物流行病学杂志》2021年第11期723-728,759,共7页Chinese Journal of Pharmacoepidemiology

基　　金：上海市临床药学重点专科建设项目[编号:沪卫计药政(2018)9号];上海市松江区科技攻关项目(编号:19sjkjgg156)。

摘　　要：目的:探讨肺栓塞患者华法林抗凝质量和出血不良事件的可能影响因素。方法:使用上海市松江区中心医院电子病历管理系统(HIS)收集2016年7月~2020年7月接受华法林治疗的126例肺栓塞患者的临床资料,包括患者年龄、性别、吸烟史、酗酒史、症状体征(咳嗽、胸闷、咯血、是否长期卧床)、合并疾病、实验室检查(凝血指标、血气分析)、治疗药物等,采用单因素分析和多因素Logistic回归分析评估可能影响华法林抗凝疗效及出血的因素。结果:126例患者中,57例的治疗窗内时间百分比(TTR)≥58%,TTR达标率为45.23%。奥美拉唑[OR=3.717,95%CI(1.280,10.795),P=0.016]、茶碱制剂[OR=3.643,95%CI(1.327,10.004),P=0.012]及冠心病史[OR=0.158,95%CI(0.039,0.644),P=0.010]可显著影响华法林的抗凝质量。共有15例患者发生出血事件,发生率为11.90%,年龄[OR=1.32,95%CI(1.035,1.682),P=0.025]及肾功能不全[OR=27,95%CI(6.165,118.256),P<0.001]可显著增加华法林的出血风险。结论:肺栓塞患者华法林抗凝质量的影响因素有联合使用质子泵抑制药、茶碱制剂以及合并冠心病;影响出血的危险因素有年龄及肾功能不全。临床医师在诊疗过程中应关注上述因素,确保华法林的疗效及安全性。Objective:To explore the possible influencing factors of the quality of anticoagulation and bleeding adverse events in patients with pulmonary embolism.Methods:The electronic medical record management system(HIS)of Shanghai Songjiang District Central hospital was used to collect clinical data of 126 patients with pulmonary embolism who received warfarin from July 2016 to July 2020,including the patient’s age,gender,smoking history,history of alcoholism,symptoms and signs(cough,chest tightness,hemoptysis,long-term bed rest),comorbid diseases,laboratory tests(coagulation index,blood gas analysis),therapeutic drugs,etc.,using single factor analysis of variance and multivariate regression analysis to evaluate the effect of warfarin on anticoagulation and the possibility of bleeding factor.Results:The study found that among the patients included in the study,57 had TTR≥58%,and the TTR compliance rate was 45.23%.Omeprazole(OR=3.717,95%CI 1.280 to 10.795,P=0.016),theophylline preparation(OR=3.643,95%CI 1.327 to 10.004,P=0.012)and history of coronary heart disease(OR=0.158,95%CI 0.039 to 0.644,P=0.010)could significantly affect the anticoagulant quality of warfarin.A total of 15 patients had bleeding events,and the incidence was 11.90%.Age(OR=1.32,95%CI 1.035 to 1.682,P=0.025)and renal insufficiency(OR=27,95%CI 6.165 to 118.256,P<0.001)could significantly increase the bleeding risk of warfarin.Conclusion:The factors affecting the anticoagulant quality of warfarin in patients with pulmonary embolism include the combined use of proton pump inhibitors,theophylline and coronary heart disease;The risk factors of bleeding were age and renal insufficiency.Clinicians should pay attention to the above factors in the process of diagnosis and treatment to ensure the efficacy and safety of warfarin.

关 键 词：肺栓塞 华法林 抗凝质量 出血事件 影响因素 

分 类 号：R973.2[医药卫生—药品]