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