摘要目的：探讨延续护理对心脏瓣膜置换术后患者抗凝治疗的影响。方法将2012年9月—2013年8月共153例行心脏瓣膜置换术的患者,按便利抽样法随机分为对照组77例,干预组76例；两组患者在住院期间均接受常规的健康教育和出院指导,对照组在出院后1周完成电话随访,干预组分别于出院后1周、1,3,6个月、1年予电话随访、病房回访、集体授课、个别讲解等护理干预,1年后评价两组患者服药依从性和抗凝治疗效果。结果1年后,干预组患者抗凝认知程度分别为完全认知89.04%,部分认知9.59,完全不认知1.37%,优于对照组的70.27%,20.27%,9.46%,差异有统计学意义(χ2=8.847,P=0.012)；干预组服药依从性分别为完全依从97.26%,部分依从1.37%,完全不依从1.37%,优于对照组的86.49%,10.81%,2.70%,按时复诊为97.26%,高于对照组的87.84%,差异有统计学意义(χ2值分别为6.134,4.713；P <0.05)；干预组患者 INR 值达标率87.67%,高于对照组的70.27%,抗凝治疗并发症明显减少,其中出血发生率为6.85%,低于对照组的18.92%,差异有统计学意义(χ2值分别为6.686,4.757；P<0.05)。结论延续护理可以提高心脏瓣膜置换术后患者抗凝治疗认知程度与依从性,提高INR达标率,降低抗凝治疗相关并发症。

abstractsObjective To explore the continuing nursing care effect on anticoagulation therapy after heart valve replacement patients. Methods A total of 153 patients after heart valve replacement between September 2012 to August 2013 were randomly divided into the control group (77 cases) and intervention group (76 cases) by convenient drawing method. All patients in two groups during hospitalization received regular hospital health education and discharge education, and the patients of control group complete the telephone follow-up in 1 week after discharge, while the patients of intervention group received telephone follow-up ward visit, lectures for group and individual explanation at 1 week, 1 month, 3 months, 6 months, 1 year after discharge. 1 year later, the evaluation of patients′ medical compliance and anticoagulation effect were carried out between two groups. Results 1 year later, the recognition of anticoagulation therapy among intervention group patients obtained 89. 04%, part of recognition 9. 59%, far from recognition 1. 37%, better than 70. 27%, 20. 27%, 9. 46% of the control group (χ2 =8. 847, P =0. 012 ); the complete, part and none medication compliance of intervention group were 97. 26%, 1. 37% and 1. 37 better than 86. 49%, 10. 81%, 2. 70% of the control group;return visit on time was 97. 26% in the intervention group while 87. 84% in the control group (χ2 =6. 134, 4. 713;P<0. 05); 87. 67% patients achieved INR standard in the intervention group comparing with 70. 27% in the control group,the complication of anticoagulant therapy dramatically decreased to 6. 85%, lower than 18. 92% of the control group (χ2 =6. 686, 4. 757;P<0. 05). Conclusions Continuing nursing care can improve patient′s cognition and medication compliance of the anticoagulation therapy after heart valve replacement, improve the INR success rate, and reduce the anticoagulant therapy related complications.