摘要
目的 比较心脏机械瓣膜置换术后基层医院与三级医院的抗凝治疗情况,探讨在基层医院实施抗凝治疗的可行性及安全性.方法 161例心脏机械瓣膜置换术患者进行华法林抗凝治疗,其中观察组79例在基层医院进行抗凝治疗,对照组82例在三级医院进行抗凝治疗.比较两组患者瓣膜置换术后12个月中华法林抗凝达标率、抗凝相关并发症、抗凝相关医疗费用.结果 观察组国际标准化比值（INR）总测量次数1021次,其中抗凝达标717例次（70.2％）,对照组INR总测量次数为965次,其中抗凝达标688例次（71.3％）,两组差异无统计学意义（x2=0.274,P=0.60）.观察组出血事件13例次,对照组出血事件10例次,发生率分别为16.5％和12.2％,差异无统计学意义（x2=0.596,P=0.44）.观察组血栓事件5次,对照组血栓事件4次,发生率分别为6.3％和4.9％,差异无统计学意义（x2=0.161,P=0.69）.观察组的每例患者每月抗凝总费用低于对照组[（63.1±12.8）与（176.6±16.4）元],差异有统计学意义（t=48.716,P＜0.05）.结论 基层医院与三级医院在心脏机械瓣膜置换术后华法林抗凝治疗疗效和抗凝相关并发症方面相似,但费用较低.
Objective To assess the feasibility of anticoagulation therapy after mechanical valve replacement in grass-root health institutions.Methods One hundred and sixty one patients with mechanical valve replacement received anticoagulation therapy with warfarin,including 79 cases receiving the therapy in grass-root health institutions （test group） and 82 cases in the tertiary hospitals （control group）.The patients were followed up for 12 months after operation;the rate of anticoagulation efficacy,the anticoagulationrelated complications,and the anticoagulation-related cost were documented and compared between two groups.Results The international normalized ratio （INR） tests were performed for 1 021 times in test group and 717 times were up to anticoagulation standard （70.2 %,717/1 021）,while INR tests in control group were performed for 965 times and 688 times were up to standard （71.3%,688/965）;there were no significantly differences in efficacy rate between two groups （P 〉 0.05）.There were no significant differences in rate of bleeding events and thrombosis between two groups [16.5% （13/79） vs.12.2% （10/82）,6.3%（5/79） vs.4.9%（4/82）,respectively,x2 =0.596,P=0.44,x2 =0.161,P=0.69].The anticoagulation-related cost per month and per patient in test group was significantly lower than those in control group [（63.1 ±.12.8） vs.（176.6 ± 16.4） yuan,t =48.716,P 〈0.05].Conclusion Compared with the tertiary hospital,the anticoagulation therapy in grass-root institutions can accomplish the similar clinical outcomes and significantly reduce the medical cost in patients with mechanical valve replacement.
出处
《中华全科医师杂志》
2015年第8期607-610,共4页
Chinese Journal of General Practitioners
关键词
心脏瓣膜假体置入
华法林
抗凝治疗
医院
综合
医院
基层
Heart valve prothesis implantation
Warfarin
Anticoagulation therapy
Hospitals,general
Hospitals,community
