医护药共同管理模式对心脏瓣膜置换术后患者抗凝管理的效果研究  

Effect of joint management mode by doctors,nurses,and pharmacists on anticoagulant management of patients after heart valve replacement

作　　者：项梅[1] 吕海玉 XIANG Mei;LV Hai-yu(Department of Cardiac Surgery,Hainan General Hospital,Haikou 570311,Hainan,CHINA)

机构地区：[1]海南省人民医院心脏外科,海南海口570311

出　　处：《海南医学》2024年第12期1820-1824,共5页Hainan Medical Journal

基　　金：2021年度海南省卫生厅课题(编号:21A200187)。

摘　　要：目的评估医护药共同管理模式对心脏瓣膜置换术后患者抗凝管理的效果,以探索心脏瓣膜置换术后患者抗凝管理的新模式。方法采用整群抽样法选取2022—2023年海南省人民医院心脏外科收治的264例心脏瓣膜置换术患者作为研究对象,其中2022年1~6月收治的132例患者纳入对照组,实施医护共同管理模式;2023年1~6月收治的132例患者纳入干预组,实施医护药共同管理模式。分别于出院时和出院后6个月采用华法林抗凝知识问卷调查表、华法林抗凝治疗依从性问卷调查表、华法林抗凝监测记录表、抗凝宣教满意率问卷调查表评价两组患者的抗凝知识掌握程度、抗凝依从性(包括服药依从性、监测依从性和生活方式依从性)、INR值达标率、抗凝不良事件发生率和抗凝宣教满意率。结果出院时和出院后6个月,干预组患者的抗凝知识掌握程度好的患者分别为102例(72.7%)和74例(56.1%),明显高于对照组的82例(62.1%)和37例(28.1%),差异均有统计学意义(P<0.05);出院时和出院后6个月,两组患者的抗凝依从性总分和三个维度得分比较差异均无统计学意义(P>0.05);两组患者出院时和出院后6个月的INR值达标率比较差异均无统计学意义(P>0.05),但两组患者出院后的INR值达标率均明显低于出院时,差异均有统计学意义(P<0.001);出院时和出院后6个月,两组患者的抗凝不良事件发生率比较差异均无统计学意义(P>0.05),但出院后6个月,两组患者的抗凝不良事件发生率均高于出院时,差异均具有显著统计学意义(P<0.01);出院时两组患者的抗凝宣教满意率比较差异无统计学意义(P>0.05),出院后6个月的抗凝宣教满意率比较差异亦无统计学意义(P>0.05),同时,出院后6个月两组患者的抗凝宣教满意率均低于出院时,差异均具有统计学意义(P<0.05)。结论医护药共同管理模式能够提高心脏瓣膜置换术后患者的抗凝知识掌握程�Objective To evaluate the effect of joint management mode by doctors,nurses,and pharmacists on anticoagulant management of patients after heart valve replacement,in order to explore a new mode of anticoagulant management of patients after heart valve replacement.Methods A total of 264 patients undergoing heart valve replacement in the Department of Cardiac Surgery,Hainan General Hospital from 2022 to 2023 were selected as the study subjects by cluster sampling method,of which 132 from January 2022 to June 2022 were selected as the control group to receive joint management mode by doctors and nurses,and 132 from January 2023 to June 2023 were selected as the intervention group to receive joint management mode by doctors,nurses,and pharmacists.The mastery level of anticoagulation knowledge,anticoagulant compliance(including medication compliance,monitoring compliance,and lifestyle compliance),the standard-reaching rates of international normalized ratio(INR),the incidence of anticoagulant adverse events,and the satisfaction rate of anticoagulation education of the two groups were evaluated by Warfarin anticoagulant knowledge questionnaire,Warfarin anticoagulant treatment compliance questionnaire,Warfarin anticoagulant monitoring record form,and anticoagulant education satisfaction questionnaire at discharge and 6 months after discharge,respectively.Results At discharge and 6 months after discharge,102(72.7%)and 74(56.1%)patients in the intervention group had good mastery of anticoagulation knowledge,which were significantly higher than 82(62.1%)and 37(28.1%)in the control group,respectively(P<0.05).At discharge and 6 months after discharge,there was no significant difference in the total score and three dimensions of anticoagulation compliance between the two groups(P>0.05).There was no significant difference in the standard-reaching rate of INR between the two groups at discharge and 6 months after discharge(P>0.05);the rates at 6 months after discharge in both groups were significantly lower than those at dischar

关 键 词：心脏瓣膜置换 华法林 医护药共同管理模式 抗凝管理 

分 类 号：R473.6[医药卫生—护理学]