心脏机械瓣膜置换术后患者院外早期抗凝监测的依从性及其影响因素

目的调查心脏机械瓣膜置换术后患者院外早期抗凝监测的依从性现状，并探讨其影响因素，为制订有针对性的健康教育策略提供依据。方法采用自行设计的患者抗凝监测依从性问卷、华法林抗凝治疗认知情况调查表、焦虑自评量表、抑郁自评量表和社会支持评定量表，以门诊复诊和电话随访的方式对115例心脏机械瓣膜置换术后6个月口服华法林进行抗凝治疗的患者进行问卷调查。结果患者早期抗凝监测依从性得分为（2．73±0．84）分，63．5％的患者依从性好，36．5％的患者依从性差；监测依从性与华法林抗凝认知情况、文化程度、客观支持和就业情况呈正相关（P〈0．05）。结论患者抗凝监测依从性尚待提高，护理人员应加强对患者华法林抗凝相关知识的宣教，特别是文化程度较低、客观社会支持较差以及抗凝认知不足的在岗患者，以提高其对术后华法林抗凝监测的重视，降低抗凝相关并发症的发生率及再住院率。

Compliance of Early Extramural Hospital Anticoagulant Monitoring and Its Influencing Factors in Patients with Mechanical Heart Valve Replacement

Objective To investigate the level and influencing factors of warfarin anticoagulant monitoring compliance in patients with mechanical heart valve replacement, so as to provide evidences for developing targeted health education strategies. Methods A total of 115 patients underwent mechanical heart valve replacement six months before were investigated by a self-designed questionnaire about the compliance of early anticoagulant monitoring and cognitive status of anticoagulation by warfarin,Self-rating anxiety scale （SAS） ,Self-rating depressive scale （SDS） and Social Support Rating Scale （SSRS）. They were interviewed on outpatient appointment or telephoned to complete the questionnaires. Results The score of anticoagula- tion monitoring compliance was（2.73±0.84）, about 63.5% of patients were satisfactory and 36.5%were unsatisfactory, which was positively correlated with anticoagulation cognitive status, education level, objective support and employment status（P〈0.05）. Conclusion The level of anticoagulant monitoring compliance in patients with mechanical heart valve replacement remained to be improved. Nursing staff should take measures to enhance health education, improve compliance of monitoring, so as to increase its commitment to warfarin anticoagulant postoperatively monitoring and decrease incidence of postoperative complications and readmission, especially for the patients with lower cultural degree, unsubstantial objec- tive social support, anticoagulation cognition deficiency and on-the-job.