期刊文献+

护士主导的心房颤动导管消融术后抗凝管理评价 被引量:5

Nurse-led anticoagulation management service in patients underwent catheter ablation for atrial fibrillation:reduce bleeding and thrombosis events
原文传递
导出
摘要 目的 探讨护士主导的抗凝管理服务(AMS)与心房颤动(房颤)导管消融术后患者华法林抗凝治疗窗内时间(TTR)及出血/缺血性事件的相关性.方法 自2011年5月至2015年7月连续在首都医科大学附属北京朝阳医院房颤中心接受导管消融治疗的房颤患者901例[男472例,年龄(64±11)岁],术后常规接受口服华法林抗凝治疗3~6个月,脑卒中风险高者会延长华法林使用时间或长期服用华法林.所有患者均由专职护士对抗凝进行管理,2011年5月至2012年12月为学习曲线期(甲组,n=295例),2013年1月至2015年7月为成熟期(乙组,n=606例).比较两组的出血/缺血性事件率、TTR、国际标准化比值(INR)波动指数(达标后的最大INR值-达标后最小INR值-1).结果 乙组出血/缺血事件发生率显著低于甲组(7.4%对11.5%,P=0.045),INR滴定时间[(8.9±5.1)d对(10.4±4.7)d,P<0.001),INR波动指数(0.64±0.54对0.75±0.53,P<0.05)均低于甲组,乙组TTR(73%±20%)则高于甲组(66%±20%),P<0.001.结论 护士主导的房颤射频消融术后抗凝管理,经过学习曲线训练,能够提高患者应用华法林抗凝的TTR窗,减小INR值的波动性,降低出血/缺血性事件. Objective To evaluate the effectiveness of anticoagulation management service(AMS) in patients who underwent catheter ablation for atrial fibrillation(AF).Methods From May 2011 to July 2015,901 consecutive patients[472 in male,age (64± 11) years] with AF ablation in Beijing Chaoyang Hospital were enrolled.All patients received warfarin therapy for 3~6 months or longer after catheter ablation for AF.Patients adjusted their warfarin doses under the guidance of nurse.Group 1:295 cases underwent ablation from May 2011 to December 2012(the nurse was under the study curve);Group 2:606 cases underwent procedure from January 2013 to July 2015(the nurse was well-done trained).The percentage of time in therapeutic range(TTR),international nonmalized ratio (INR)fluctuation index,minor/major hemorrhage and thromboembolic events were recorded.Results TTR of group 2 was 73%±20%,which higher than group 1(66%±20%),P<0.001.The INR fluctuation index in group 2 was significantly less than that in group 1 [(0.64±0.54)vs.(0.75±0.53),P<0.05].The ratio of bleeding and thrombosis events was 11.5% and 7.4% in group 1 and group 2,respectively.Conclusion This study demonstrates that well-trained nurse-led AMS in patients who underwent catheter ablation of AF is helpful in achieving higher effective anticoagulation rate while reducing bleeding and thrombosis events.
出处 《中华心律失常学杂志》 2016年第5期400-403,408,共5页 Chinese Journal of Cardiac Arrhythmias
关键词 抗凝管理服务 心房颤动 导管消融 国际标准化比值 护士 Anticoagulation management service Atrial fibrillation Catheter ablation International normalized ratio Nurse
  • 相关文献

参考文献1

二级参考文献9

  • 1Camm AJ, Kirchhof P, Lip GY, et al. Guidelines for the manage- ment of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology ( ESC ). Europace ,2010,12 : 1360-1420. 被引量:1
  • 2Oral H, Chugh A, Ozaydin M, et al. Risk of thromboembolic events after percutaneous left atrial radiofrequency ablation of atrial fibril- lation. Circulation,2006,114:759-765. 被引量:1
  • 3Johnson SG, Witt DM, Eddy TR, et al. Warfarin and antiplatelet combination use among commercially insured patients enrolled in an anticoagulation management service. Chest,2007,131 : 1500-1507. 被引量:1
  • 4Staresinic AG, Sorkness CA, Goodman BM, et al. Comparison of outcomes using 2 delivery models of anticoagulation care. Arch In- tern Med ,2006,166:997-1002. 被引量:1
  • 5Lalonde L, Martineau J, Blais N, et al. Is long-term pharmacist- managed anticoagulation service efficient? A pragmatic randomized controlled trial. Am Heart J,2008,156:148-154. 被引量:1
  • 6Hendriks JM, de Wit R, Crijns HJ, et al. Nurse-led care vs. usual care for patients with atrial fibrillation : results of a randomized tri- al of integrated chronic care vs. routine clinical care in ambulatory patients with atrial fibrillation. Eur Heart J,2012, doi: 10. 1093/ eurheartj/ehso71. 被引量:1
  • 7Abdelhafiz AH, Wheeldon NM. Results of an open-label, prospec- tive study of anticoagulant therapy for atrial fibrillation in an outpa- tient anticoagulation clinic. Clin Ther,2004,26 : 1470-1478. 被引量:1
  • 8Bungard TJ, Gardner L, Archer SL, et al. Evaluation of a pharma- cist-managed anticoagulation clinic: Improving patient care. Open Med,2009,3 : e16-21. 被引量:1
  • 9黄从新,马长生,张澍,曹克将,黄德嘉,吴书林,江洪,马坚,刘少稳,杨延宗,杨新春,张奎俊,李莉,刘旭,丁燕生,商丽华,王方正,陈新.经导管消融心房颤动中国专家共识[J].中华心律失常学杂志,2008,12(4):248-258. 被引量:61

共引文献3

同被引文献35

引证文献5

二级引证文献22

相关作者

内容加载中请稍等...

相关机构

内容加载中请稍等...

相关主题

内容加载中请稍等...

浏览历史

内容加载中请稍等...
;
使用帮助 返回顶部