心脏瓣膜置换术患者口服华法林依从性的分布特征及影响因素

目的 描述心脏瓣膜置换术患者口服华法林抗凝依从性的分布特征并分析影响依从性的相关因素。方法 对进行人工机械心脏瓣膜置换术患者于术后1个月、3个月、6个月、1年及2年进行电话回访，随访满2年的患者作为研究对象，计算遵从医嘱的依从率，并比较不同性别、年龄、区域、文化程度患者按时服药、按量服用药及定期复查的分布特征，分析影响依从性的因素时，按依从性分为依从性较好组和依从性较差组，进行单因素分析和多因素Logistic回归分析。结果 女性患者按剂量服药与定期复查的比率显著高于男性患者；18岁以下患者口服华法林抗凝有依从性的非常好，≤60岁组按时服药及定期复查显著低于其他年龄组；城镇和农村患者对按剂量服药的依从性有显著性差异；不同文化程度的患者服药依从性与患者本人或家属文化程度有一定相关性。结论 心脏瓣膜置换术患者口服华法林抗凝依从性受到性别、年龄、城乡区域及文化程度等因素的影响，电话回访和有针对指导利于提高患者口服华法林抗凝依从性。

Influencing factors of oral warfarin dependency and countermeasures for patients with cardiac valve replacement

AIM To study the main influencing factors of oral warfarin dependency in patients with cardiac valve replacement and present corresponding countermeasures. METHODS The present investigation chose patients with prosthetic heart valve replacement in our department who were followed up for two full years. The investigation was conducted by calling patients at 1 month, 3 months, 6 months, 1 year and 2 years after their operation. Comparision was performed of the ratio of taking warfarin on time, on dosage, and regular periodic reviewz in patients with different genders, ages, geographic regions, and educational backgrounds. RESULTS The ratio of taking warfarin on time, on dosage, and regular periodic review in female patients was significantly higher than that in male patients. Significant dependency on oral anticoagulation warfarin was found in patients under 18 years old and the ratio of taking warfarin on time and having regular periodic review in patients between 19 to 60 years old was lower than that in other groups. There was no significant difference in medication dependency between urban and rural patients; however, their medication dependency was somewhat correlated with their educational backgrounds or their family members. CONCLUSION Oral warfarin dependency in patients with cardiac valve replacement is influenced by gender, age, and educational background. Individually tailored telephone follow-up of medication can significantly improve patients’oral warfarin dependency.