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投稿时间：2023-03-08 网络发布日期：2023-11-20
投稿时间：2023-03-08 网络发布日期：2023-11-20
中文摘要: 目的 探讨护士主导的多元化护理在心脏瓣膜病术后口服华法林抗凝依从性中的应用及依从性预测模型的构建。方法 本文为前瞻性研究，选择2017年8月至2021年12月海南医学院等一附属医院126例行心脏瓣膜术患者，所有患者术后均要求服用华法林。按随机数字表法将患者分成对照组和观察组，各63例。对照组行常规护理，观察组行护士主导多元化护理干预，比较两组患者抗凝达标率、依从性评分、自我管理能力、生活质量及护理满意度等。分析口服华法林抗凝依从性的影响因素，并建立预测模型。结果 观察组患者INR达标率高于对照组（79.10% vs 64.58%, χ2=17.812, P＜0.01）。出院后6个月，观察组患者依从性评分、自我管理能力评分、生活质量评分、护理满意度高于对照组（P＜0.01）。多元线性回归分析显示，年龄、家庭年收入、护理模式及文化程度是口服华法林抗凝依从性的影响因素，且预测模型为Y=-1.066+0.458X年龄-0.451X护理模式-0.896X文化程度-0.199X家庭年收入。结论 护士主导的多元化护理可有效提高心脏瓣膜术患者的抗凝达标率和依从性评分，增强患者自我管理能力，改善生活质量，提高心脏瓣膜病术后护理满意度，年龄、家庭年收入、护理模式及文化程度是影响口服华法林抗凝依从性的因素。
Abstract:Objective To investigate the application of nurse-led diversified care and the construction of compliance prediction model for oral warfarin anticoagulation after cardiac valve surgery. Methods This was a prospective study that included a total of 126 patients who underwent cardiac valve surgery at the First Affiliated Hospital of Hainan Medical College from August 2017 to December 2021 and were prescribed oral warfarin postoperatively. The patients were randomly divided into a control group and an observation group, with 63 patients in each group. The control group received routine nursing care, while the observation group received nurse-led diversified care intervention. The two groups were compared in terms of anticoagulation target attainment rate, compliance scores, self-management ability, quality of life, and satisfaction with nursing care. Factors influencing oral warfarin anticoagulation compliance were analyzed, and a prediction model was established. Results The observation group had a higher INR target attainment rate compared to the control group (79.10% vs 64.58%, χ2=17.812, P＜0.01). At 6 months after discharge, the observation group had higher compliance scores, self-management ability scores, quality of life scores, and patient satisfaction compared to the control group (P＜0.01). Multiple linear regression analysis revealed that age, family annual income, nursing mode, and education level were factors influencing oral warfarin anticoagulation compliance. The prediction model was as follows: Y=-1.066+0.458Xage-0.451Xnursing mode-0.896Xeducation level-0.199Xfamily annual income. Conclusion Nurse-led diversified care can effectively improve the anticoagulation target attainment rate and compliance scores of patients undergoing cardiac valve surgery, enhance their self-management ability, improve their quality of life, and achieve high satisfaction with postoperative nursing care. Age, family annual income, nursing mode, and education level are factors influencing oral warfarin anticoagulation compliance.
keywords: Valvular heart disease Warfarin Anticoagulant agents Compliance Self-management ability score Diversified care
文章编号： 中图分类号： 文献标志码：B
基金项目:海南省卫生健康行业科研项目（20A200060）
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引用文本：
陈桂尼， 刘运仲， 王月婵， 陈少丽， 何瑞玲.护士主导的多元化护理在心脏瓣膜疾病术后口服华法林抗凝依从性中的作用[J].中国临床研究,2023,36(11):1744-1748,1753.
陈桂尼， 刘运仲， 王月婵， 陈少丽， 何瑞玲.护士主导的多元化护理在心脏瓣膜疾病术后口服华法林抗凝依从性中的作用[J].中国临床研究,2023,36(11):1744-1748,1753.