CAJ | 학술논문

目的：观察高龄非瓣膜病性房颤（NVAF）患者长期应用华法林抗凝治疗的疗效及安全性。方法入选NVAF患者按年龄分为3组，高龄老年组55例，年龄≥80岁（INR在1.6~2.5之间）；老年组45例，年龄65~79岁（INR在l.6~2.5之间）；中年组37例，年龄＜65岁（INR在2.0~3.0）。入选患者长期服用华法林抗凝治疗，根据INR测定值及其变化趋势来调整华法林剂量，使INR达标，比较3组患者口服华法林5年时的不良反应及华法林的安全用药范围及国际标准化比值（INR）。结果5年随访期间，三组患者均未发生缺血性卒中，三组患者出血及其他不良反应无统计学差异（P＞0.05）。随访第5年时，高龄老年组华法林组剂量（2.89±0.52）mg，INR（2.15±0.31），老年华法林组剂量（2.99±0.41）mg，INR （2.21±0.30），差异无统计学意义（P＞0.05）。中年组华法林剂量（3.39±0.61）mg，INR（2.55±0.60），华法林剂量及INR明显高于高龄老年组和老年组，差异有统计学意义（P＜0.05）。结论严密监测INR下，对于高龄老年NVAF患者应用华法林抗凝治疗，INR控制在1.5～2.5安全有效。
목적：관찰고령비판막병성방전（NVAF）환자장기응용화법림항응치료적료효급안전성。방법입선NVAF환자안년령분위3조，고령노년조55례，년령≥80세（INR재1.6~2.5지간）；노년조45례，년령65~79세（INR재l.6~2.5지간）；중년조37례，년령＜65세（INR재2.0~3.0）。입선환자장기복용화법림항응치료，근거INR측정치급기변화추세래조정화법림제량，사INR체표，비교3조환자구복화법림5년시적불량반응급화법림적안전용약범위급국제표준화비치（INR）。결과5년수방기간，삼조환자균미발생결혈성졸중，삼조환자출혈급기타불량반응무통계학차이（P＞0.05）。수방제5년시，고령노년조화법림조제량（2.89±0.52）mg，INR（2.15±0.31），노년화법림조제량（2.99±0.41）mg，INR （2.21±0.30），차이무통계학의의（P＞0.05）。중년조화법림제량（3.39±0.61）mg，INR（2.55±0.60），화법림제량급INR명현고우고령노년조화노년조，차이유통계학의의（P＜0.05）。결론엄밀감측INR하，대우고령노년NVAF환자응용화법림항응치료，INR공제재1.5～2.5안전유효。
Objective To observe the efficacy and safety of warfarin in long-time anticoagulation treatment in elderly patients with nonvalvular atrial fibrillation (NVAF).Methods NVAF patients were divided into 3 groups according to their ages: advanced elderly group [n=55, age≥80, and international normalized ratio (INR) controlled from l.6 to 2.5], elderly group (n=45, aged from 65 to 79, and INR controlled from l.6 to 2.5) and middle-aged group (n=37, age<65, and INR controlled from 2.0 to 3.0). All enclosed patients were given warfarin for anticoagulation treatment for a long time, and the dosage of warfarin was adjusted according to INR detection values and change trends. The adverse reactions, safe range and INR of warfarin for 5 y were compared in 3 groups.Results During 5-year follow-up period, there was no ischemia stroke observed, and there was no statistical difference in bleeding and other adverse reactions in 3 groups (P>0.05). On the 5th year, dosage of warfarin was (2.89±0.52) mg and INR was (2.15±0.31) in advanced elderly group, and (2.99±0.41) mg and (2.21±0.30) in elderly group without statistical difference (P>0.05). In middle-aged group, the dosage of warfarin was (3.39±0.61) mg and INR was (2.55±0.60), which was significantly higher than those in advanced elderly group and elderly group (P<0.05). Conclusion When warfarin is used for anticoagulation treatment effectively and safely in elderly patients with NVAF, INR should be closely monitored and controlled from 1.5 to 2.5.