CAJ | 학술논문

目的：探讨老年非瓣膜病性房颤（NVAF）患者长期应用华法林的剂量、国际标准化比值（INR）及其影响因素。方法入选老年NVAF使用华法林抗凝治疗5年以上患者110例，按年龄分为3组：≥80岁组35例、70~79岁组40例、65~69岁组35例。比较3组患者长期口服华法林的安全用药范围及INR，观察影响华法林的影响因素。结果3组患者服用华法林期间均未发生急性脑梗死及其他血管栓塞发生，出血事件发生率3组无统计学差异（P＞0.05）。≥80岁组华法林剂量（2.89±0.52）mg/d、INR （2.15±0.31）与70~79岁组华法林组剂量（2.99±0.41）mg/d、INR （2.21±0.30）比较差异无统计学意义（P＞0.05）。65~69岁组华法林剂量（3.39±0.61）mg/d, INR（2.55±0.60）明显高于≥80岁组和70~79岁组，具有统计学差异（P＜0.05）。影响老年华法林剂量调整及INR值的主要疾病为心力衰竭、甲状腺功能异常、肝肾功能异常及应用抗菌素和抗心律失常药物。结论严密监测INR下，对于＞70岁老年NVAF患者应用华法林抗凝治疗，INR控制在1.5~2.5是安全有效的，影响华法林的因素有很多，新增用药时要注意监测INR，及时调整华法林剂量。
목적：탐토노년비판막병성방전（NVAF）환자장기응용화법림적제량、국제표준화비치（INR）급기영향인소。방법입선노년NVAF사용화법림항응치료5년이상환자110례，안년령분위3조：≥80세조35례、70~79세조40례、65~69세조35례。비교3조환자장기구복화법림적안전용약범위급INR，관찰영향화법림적영향인소。결과3조환자복용화법림기간균미발생급성뇌경사급기타혈관전새발생，출혈사건발생솔3조무통계학차이（P＞0.05）。≥80세조화법림제량（2.89±0.52）mg/d、INR （2.15±0.31）여70~79세조화법림조제량（2.99±0.41）mg/d、INR （2.21±0.30）비교차이무통계학의의（P＞0.05）。65~69세조화법림제량（3.39±0.61）mg/d, INR（2.55±0.60）명현고우≥80세조화70~79세조，구유통계학차이（P＜0.05）。영향노년화법림제량조정급INR치적주요질병위심력쇠갈、갑상선공능이상、간신공능이상급응용항균소화항심률실상약물。결론엄밀감측INR하，대우＞70세노년NVAF환자응용화법림항응치료，INR공제재1.5~2.5시안전유효적，영향화법림적인소유흔다，신증용약시요주의감측INR，급시조정화법림제량。
Objective To study the dose, international normalized ratio (INR) and influencing factors of long-term taking of warfarin in elderly patients with non-valvular atrial fibrillation (NVAF). Methods NVAF patients (n=110) with warfarin anticoagulation therapy for over 5 y, were divided, according to age, into age≥80 group (n=35), age=70-79 group (n=40) and age=65-69 group (n=35). The safe medication range and INR of long-term taking of warfarin was compared among 3 groups, and influencing factors on warfarin were observed. Results There was no case with acute cerebral infarction and other vascular thrombosis in 3 groups during taking warfarin, and incidence of bleeding events had no statistical difference among 3 groups (P>0.05). The difference in warfarin dose [(2.89± 0.52) mg/d vs. 2.99±0.41) mg/d] and INR [(2.15±0.31) vs. (2.21±0.30)] had no statistical significance between age≥80 group and age=70-79 group (P>0.05). The dose of warfarin [(3.39±0.61) mg/d] and INR (2.55±0.60) were significantly higher in age=65-69 group than those in age=≥80 group and age=70-79 group (P<0.05). The diseases influencing on warfarin dose and INR included mainly heart failure, abnormal thyroid function, dysfunction of liver and kidney, and administration of antibiotics and antiarrhythmic drugs. Conclusion INR controlled from 1.5 to 2.5 will be safe and effective in elderly NVAF patients (age>70) taking warfarin for anticoagulation treatment. There were many influencing factors on dose of warfarin, so INR should be monitored and the dose should be adjusted timely.