CAJ | 학술논문

目的：探讨延续护理对心脏瓣膜置换术后患者抗凝治疗的影响。方法将2012年9月—2013年8月共153例行心脏瓣膜置换术的患者,按便利抽样法随机分为对照组77例,干预组76例；两组患者在住院期间均接受常规的健康教育和出院指导,对照组在出院后1周完成电话随访,干预组分别于出院后1周、1,3,6个月、1年予电话随访、病房回访、集体授课、个别讲解等护理干预,1年后评价两组患者服药依从性和抗凝治疗效果。结果1年后,干预组患者抗凝认知程度分别为完全认知89.04%,部分认知9.59,完全不认知1.37%,优于对照组的70.27%,20.27%,9.46%,差异有统计学意义(χ2=8.847,P=0.012)；干预组服药依从性分别为完全依从97.26%,部分依从1.37%,完全不依从1.37%,优于对照组的86.49%,10.81%,2.70%,按时复诊为97.26%,高于对照组的87.84%,差异有统计学意义(χ2值分别为6.134,4.713；P <0.05)；干预组患者 INR 值达标率87.67%,高于对照组的70.27%,抗凝治疗并发症明显减少,其中出血发生率为6.85%,低于对照组的18.92%,差异有统计学意义(χ2值分别为6.686,4.757；P<0.05)。结论延续护理可以提高心脏瓣膜置换术后患者抗凝治疗认知程度与依从性,提高INR达标率,降低抗凝治疗相关并发症。
목적：탐토연속호리대심장판막치환술후환자항응치료적영향。방법장2012년9월—2013년8월공153례행심장판막치환술적환자,안편리추양법수궤분위대조조77례,간예조76례；량조환자재주원기간균접수상규적건강교육화출원지도,대조조재출원후1주완성전화수방,간예조분별우출원후1주、1,3,6개월、1년여전화수방、병방회방、집체수과、개별강해등호리간예,1년후평개량조환자복약의종성화항응치료효과。결과1년후,간예조환자항응인지정도분별위완전인지89.04%,부분인지9.59,완전불인지1.37%,우우대조조적70.27%,20.27%,9.46%,차이유통계학의의(χ2=8.847,P=0.012)；간예조복약의종성분별위완전의종97.26%,부분의종1.37%,완전불의종1.37%,우우대조조적86.49%,10.81%,2.70%,안시복진위97.26%,고우대조조적87.84%,차이유통계학의의(χ2치분별위6.134,4.713；P <0.05)；간예조환자 INR 치체표솔87.67%,고우대조조적70.27%,항응치료병발증명현감소,기중출혈발생솔위6.85%,저우대조조적18.92%,차이유통계학의의(χ2치분별위6.686,4.757；P<0.05)。결론연속호리가이제고심장판막치환술후환자항응치료인지정도여의종성,제고INR체표솔,강저항응치료상관병발증。
Objective To explore the continuing nursing care effect on anticoagulation therapy after heart valve replacement patients. Methods A total of 153 patients after heart valve replacement between September 2012 to August 2013 were randomly divided into the control group (77 cases) and intervention group (76 cases) by convenient drawing method. All patients in two groups during hospitalization received regular hospital health education and discharge education, and the patients of control group complete the telephone follow-up in 1 week after discharge, while the patients of intervention group received telephone follow-up ward visit, lectures for group and individual explanation at 1 week, 1 month, 3 months, 6 months, 1 year after discharge. 1 year later, the evaluation of patients′ medical compliance and anticoagulation effect were carried out between two groups. Results 1 year later, the recognition of anticoagulation therapy among intervention group patients obtained 89. 04%, part of recognition 9. 59%, far from recognition 1. 37%, better than 70. 27%, 20. 27%, 9. 46% of the control group (χ2 =8. 847, P =0. 012 ); the complete, part and none medication compliance of intervention group were 97. 26%, 1. 37% and 1. 37 better than 86. 49%, 10. 81%, 2. 70% of the control group;return visit on time was 97. 26% in the intervention group while 87. 84% in the control group (χ2 =6. 134, 4. 713;P<0. 05); 87. 67% patients achieved INR standard in the intervention group comparing with 70. 27% in the control group,the complication of anticoagulant therapy dramatically decreased to 6. 85%, lower than 18. 92% of the control group (χ2 =6. 686, 4. 757;P<0. 05). Conclusions Continuing nursing care can improve patient′s cognition and medication compliance of the anticoagulation therapy after heart valve replacement, improve the INR success rate, and reduce the anticoagulant therapy related complications.