标题：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

      作者：项梅，吕海玉    海南省人民医院心脏外科，海南 海口 570311

      卷次： 2024年35卷12期

      【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度和抗凝宣教满意率，适用于心脏瓣膜置换术后患者的抗凝管理。但即便引入临床药师增强了住院期间抗凝管理力度，对出院后的抗凝管理效果仍然影响甚微，需要继续探索心脏瓣膜置换术后患者出院后的抗凝管理新思路。
      【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
      【中图分类号】 R473.6 【文献标识码】 A 【文章编号】 1003—6350（2024）12—1820—05

Effect of joint management mode by doctors, nurses, and pharmacists on anticoagulant management of patientsafter heart valve replacement.
XIANG Mei, LV Hai-yu. Department of Cardiac Surgery, Hainan General Hospital, Haikou570311, Hainan, CHINA
【Abstract】 Objective To evaluate the effect of joint management mode by doctors, nurses, and pharmacists onanticoagulant management of patients after heart valve replacement, in order to explore a new mode of anticoagulantmanagement of patients after heart valve replacement. Methods A total of 264 patients undergoing heart valve replace-ment in the Department of Cardiac Surgery, Hainan General Hospital from 2022 to 2023 were selected as the study sub-jects by cluster sampling method, of which 132 from January 2022 to June 2022 were selected as the control group to re-ceive joint management mode by doctors and nurses, and 132 from January 2023 to June 2023 were selected as the inter-vention group to receive joint management mode by doctors, nurses, and pharmacists. The mastery level of anticoagula-tion knowledge, anticoagulant compliance (including medication compliance, monitoring compliance, and lifestyle com-pliance), the standard-reaching rates of international normalized ratio (INR), the incidence of anticoagulant adverseevents, and the satisfaction rate of anticoagulation education of the two groups were evaluated by Warfarin anticoagulantknowledge questionnaire, Warfarin anticoagulant treatment compliance questionnaire, Warfarin anticoagulant monitoringrecord form, and anticoagulant education satisfaction questionnaire at discharge and 6 months after discharge, respective-ly. Results At discharge and 6 months after discharge, 102 (72.7%) and 74 (56.1%) patients in the intervention grouphad good mastery of anticoagulation knowledge, which were significantly higher than 82 (62.1%) and 37 (28.1%) in thecontrol group, respectively (P<0.05). At discharge and 6 months after discharge, there was no significant difference inthe total score and three dimensions of anticoagulation compliance between the two groups (P>0.05). There was no sig-nificant difference in the standard-reaching rate of INR between the two groups at discharge and 6 months after dis-charge (P>0.05); the rates at 6 months after discharge in both groups were significantly lower than those at discharge (P<0.001). There was no significant difference in the incidence of adverse events between the two groups at dischargeand 6 months after discharge (P>0.05); the incidences of adverse events in both groups at 6 months after discharge weresignificantly higher than those at discharge (P<0.001). At discharge and 6 months after discharge, there was no signifi-cant difference in the satisfaction rate of anticoagulation education between the two groups (P>0.05); the satisfactionrates at 6 months after discharge in both groups were lower than those at discharge (P<0.05). Conclusion The jointmanagement model by doctors, nurses, and pharmacists can improve the mastery of anticoagulation knowledge and satis-faction rate of anticoagulation education in patients after heart valve replacement, which is suitable for anticoagulantmanagement in patients after heart valve replacement surgery. However, although the introduction of clinical pharma-cists enhanced the anticoagulant management during hospitalization, it had little impact on the anticoagulant manage-ment effect after discharge. Thus, it is necessary to explore new ideas for the anticoagulant management of patients afterheart valve replacement after discharge.
      【Key words】 Heart valve replacement; Warfarin; Joint management model by doctors, nurses, and pharmacists;Anticoagulant management