抗凝团队在房颤患者围术期抗凝宣教中的作用和价值
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摘要
目的:探讨抗凝团队对房颤患者围术期抗凝宣教的作用和价值。方法:对2017年1～6月就诊于上海交通大学医学院附属仁济医院的房颤患者,接受抗凝团队的围术期抗凝宣教,对宣教前后患者的抗凝知识进行问卷评分并对比,同时探讨不同年龄和学历对得分的影响。结果:本研究共纳入172名患者,其中包括行射频消融术患者142例,左心耳封堵术患者27例,射频消融术联合左心耳封堵术3例,选择达比加群酯116例,华法林53例,利伐沙班3例;根据患者服用的抗凝药物,抗凝团队进行抗凝宣教后,患者的抗凝知识问卷评分得到明显提高(P <0. 05);对于服用华法林患者,大专及以上学历宣教后得分显著高于初中及以下学历(P <0. 05),年龄≥75岁患者宣教后得分显著低于其他年龄层次(P <0. 05);对于服用新型口服抗凝药患者,大专及以上学历宣教前得分显著高于初中及以下学历(P <0. 05),年龄≥75岁患者宣教后得分显著低于年龄<60岁患者(P <0. 05)。结论:抗凝团队参与房颤患者围术期的抗凝宣教可提高其治疗的依从性。
Objective: To investigate the effect of anticoagulation education and research group in perioperative patients with atrial fibrillation. Methods: Anticoagulation education and research group performed education to atrial fibrillation patients admitted to Renji hospital from January to June 2017. The scores of anticoagulation knowledge questionnaires before and after the mission were compared,and the impact of different ages and degrees on which were explored. Results: A total of 172 patients were enrolled in the study including 142 patients undergoing AF ablation,27 patients undergoing left atrial appendage occlusion,3 patients undergoing AF ablation as well as left atrial appendage occlusion. Totally 116 patients were treated with dabigatran,53 patients were treated with warfarin and 3 patients were treated with rivaroxaban. The scores of anticoagulation knowledge questionnaires of patients were significantly improved after the anticoagulation education (P < 0. 05). For patients taking warfarin,the scores with junior college education or above were significantly higher than those with junior high school or below after education (P < 0. 05),and the scores of patients aged ≥75years were significantly lower than other age groups after education (P < 0. 05). For patients taking NOACs,the scores with junior college education or above were significantly higher than those with junior high school or below before education (P < 0. 05),and those aged ≥75 years were significantly lower than those aged < 60 years after education (P < 0. 05). Conclusion: Anticoagulation education and research group can improve the treatment compliance of perioperative patients with atrial fibrillation.
Objective: To investigate the effect of anticoagulation education and research group in perioperative patients with atrial fibrillation. Methods: Anticoagulation education and research group performed education to atrial fibrillation patients admitted to Renji hospital from January to June 2017. The scores of anticoagulation knowledge questionnaires before and after the mission were compared,and the impact of different ages and degrees on which were explored. Results: A total of 172 patients were enrolled in the study including 142 patients undergoing AF ablation,27 patients undergoing left atrial appendage occlusion,3 patients undergoing AF ablation as well as left atrial appendage occlusion. Totally 116 patients were treated with dabigatran,53 patients were treated with warfarin and 3 patients were treated with rivaroxaban. The scores of anticoagulation knowledge questionnaires of patients were significantly improved after the anticoagulation education (P < 0. 05). For patients taking warfarin,the scores with junior college education or above were significantly higher than those with junior high school or below after education (P < 0. 05),and the scores of patients aged ≥75years were significantly lower than other age groups after education (P < 0. 05). For patients taking NOACs,the scores with junior college education or above were significantly higher than those with junior high school or below before education (P < 0. 05),and those aged ≥75 years were significantly lower than those aged < 60 years after education (P < 0. 05). Conclusion: Anticoagulation education and research group can improve the treatment compliance of perioperative patients with atrial fibrillation.
引文
1孙飞龙,赵庆春,汤雨虹,等.心房颤动患者导管射频消融术后利伐沙班抗凝治疗的回顾分析[J].中国药师,2017,20(1):124-126
2 Camm AJ,Lip GY,De Caterina R,et al.2012 focused update of the ESC Guidelines for the management of atrial fibrillation An update of the 2010 ESC Guidelines for the management of atrial fibrillation Developed with the special contribution of the European Heart Rhythm Association[J].Eur Heart J,2012,33(21):2719-2747
3 Siu CW,Lau CP,Lee WL,et al.Intravenous diltiazem is superior to intravenous amiodarone or digoxin for achieving ventricular rate control in patients with acute uncomplicated atrial fibrillation[J].Crit Care Med,2009,37(7):2174-2179
4黄从新,张澍.心房颤动:目前的认识和治疗建议-2015[J].中华心律失常学杂志,2015,19(5):321-384
5 Cappato R,Calkins H,Chen SA,et al.Worldwide survey on the methods,efficacy,and safety of catheter ablation for human atrial fibrillation[J].Circulation,2005,111(9):1100-1105
6蒋捷,谢秋芬,向倩,等.药师干预对华法林抗凝患者治疗认知度的影响研究[J].中国临床药理学杂志,2015,31(13):1315-1317
7 Jais P,Hocini M,Sanders P,et al.Long-term evaluation of atrial fibrillation ablation guided by noninducibility[J].Heart Rhythm,2006,3(2):140-145
8 Gaita F,Caponi D,Pianelli M,Radiofrequency catheter ablation of atrial fibrillation:a cause of silent thromboembolism?Magnetic resonance imaging assessment of cerebral thromboembolism in patients undergoing ablation of atrial fibrillation[J].Circulation,2010,122(17):1667-1673
9 Block PC,Burstein S,Casale PN,et al.Percutaneous left atrial appendage occlusion for patients in atrial fibrillation suboptimal forwarfarin therapy:5-year results of the PLAATO(Percutaneous Left Atrial Appendage Transcatheter Occlusion)Study[J].JACC:Cardiovascular Interventions,2009,2(7):594
10 John Camm A,Colombo A,Corbucci G,et al.Left atrial appendage closure:a new technique for clinical practice[J].Heart Rhythm,2014,11(3):514-521
11王颖,谭湘萍,严鹏科.房颤合并冠心病患者服用华法林致INR异常1例的药学监护[J].中国药师,2015,18(1):105-108
12 Buckley MS,Goff AD,Knapp WE.Fish oil interaction with warfarin[J].Ann Pharmacother,2004,38(1):50-52
13 Wiggins BS,Northup A,Johnson D,et al.Reduced anticoagulant effect of dabigatran in a patient receiving concomitant phenytoin[J].Pharmacotherapy,2016,36(2):e5-7
14 Chin PK,Wright DF,Zhang M,et al.Correlation between trough plasma dabigatran concentrations and estimates of glomerular filtration rate based on creatinine and cystatin C[J].Drugs R D,2014,14(2):113-123
15 Chang SH,Chou IJ,Yeh YH,et al.Association between use of nonvitamin K oral anticoagulants with and without concurrent medications and risk of major bleeding in nonvalvular atrial fibrillation[J].JAMA,2017,318(13):1250-1259
16 Altena R,van Roon E,Folkeringa R,et al.Clinical challenges related to novel oral anticoagulants:drug-drug interactions and monitoring[J].Haematologica,2014,99(2):e26-e27
17 Stollberger C,Finsterer J.Recurrent venous thrombosis under rivaroxaban and carbamazepine for symptomatic epilepsy[J].Neurol Neurochir Pol,2017,51(2):194-196
18徐宇红,孙勇.临床路径在心房颤动患者华法林抗凝治疗及健康教育中的应用[J].中国实用护理杂志,2008,24(4):13-15
19 Brandin H,Myrberg O,Rundl9f T,et al.Adverse effects by artificial grapefruit seed extract products in patients on warfarin therapy[J].Eur J Clin Pharmacol,2007,63(6):565-570
20 Norwood DA,Parke CK,Rappa LR.A comprehensive review of potential warfarin-fruit interactions[J].J Pharm Pract,2015,28(6):561-571
2 Camm AJ,Lip GY,De Caterina R,et al.2012 focused update of the ESC Guidelines for the management of atrial fibrillation An update of the 2010 ESC Guidelines for the management of atrial fibrillation Developed with the special contribution of the European Heart Rhythm Association[J].Eur Heart J,2012,33(21):2719-2747
3 Siu CW,Lau CP,Lee WL,et al.Intravenous diltiazem is superior to intravenous amiodarone or digoxin for achieving ventricular rate control in patients with acute uncomplicated atrial fibrillation[J].Crit Care Med,2009,37(7):2174-2179
4黄从新,张澍.心房颤动:目前的认识和治疗建议-2015[J].中华心律失常学杂志,2015,19(5):321-384
5 Cappato R,Calkins H,Chen SA,et al.Worldwide survey on the methods,efficacy,and safety of catheter ablation for human atrial fibrillation[J].Circulation,2005,111(9):1100-1105
6蒋捷,谢秋芬,向倩,等.药师干预对华法林抗凝患者治疗认知度的影响研究[J].中国临床药理学杂志,2015,31(13):1315-1317
7 Jais P,Hocini M,Sanders P,et al.Long-term evaluation of atrial fibrillation ablation guided by noninducibility[J].Heart Rhythm,2006,3(2):140-145
8 Gaita F,Caponi D,Pianelli M,Radiofrequency catheter ablation of atrial fibrillation:a cause of silent thromboembolism?Magnetic resonance imaging assessment of cerebral thromboembolism in patients undergoing ablation of atrial fibrillation[J].Circulation,2010,122(17):1667-1673
9 Block PC,Burstein S,Casale PN,et al.Percutaneous left atrial appendage occlusion for patients in atrial fibrillation suboptimal forwarfarin therapy:5-year results of the PLAATO(Percutaneous Left Atrial Appendage Transcatheter Occlusion)Study[J].JACC:Cardiovascular Interventions,2009,2(7):594
10 John Camm A,Colombo A,Corbucci G,et al.Left atrial appendage closure:a new technique for clinical practice[J].Heart Rhythm,2014,11(3):514-521
11王颖,谭湘萍,严鹏科.房颤合并冠心病患者服用华法林致INR异常1例的药学监护[J].中国药师,2015,18(1):105-108
12 Buckley MS,Goff AD,Knapp WE.Fish oil interaction with warfarin[J].Ann Pharmacother,2004,38(1):50-52
13 Wiggins BS,Northup A,Johnson D,et al.Reduced anticoagulant effect of dabigatran in a patient receiving concomitant phenytoin[J].Pharmacotherapy,2016,36(2):e5-7
14 Chin PK,Wright DF,Zhang M,et al.Correlation between trough plasma dabigatran concentrations and estimates of glomerular filtration rate based on creatinine and cystatin C[J].Drugs R D,2014,14(2):113-123
15 Chang SH,Chou IJ,Yeh YH,et al.Association between use of nonvitamin K oral anticoagulants with and without concurrent medications and risk of major bleeding in nonvalvular atrial fibrillation[J].JAMA,2017,318(13):1250-1259
16 Altena R,van Roon E,Folkeringa R,et al.Clinical challenges related to novel oral anticoagulants:drug-drug interactions and monitoring[J].Haematologica,2014,99(2):e26-e27
17 Stollberger C,Finsterer J.Recurrent venous thrombosis under rivaroxaban and carbamazepine for symptomatic epilepsy[J].Neurol Neurochir Pol,2017,51(2):194-196
18徐宇红,孙勇.临床路径在心房颤动患者华法林抗凝治疗及健康教育中的应用[J].中国实用护理杂志,2008,24(4):13-15
19 Brandin H,Myrberg O,Rundl9f T,et al.Adverse effects by artificial grapefruit seed extract products in patients on warfarin therapy[J].Eur J Clin Pharmacol,2007,63(6):565-570
20 Norwood DA,Parke CK,Rappa LR.A comprehensive review of potential warfarin-fruit interactions[J].J Pharm Pract,2015,28(6):561-571
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