华法林抗凝不同的国际标准化比值区间对保持血液透析患者长期导管通畅的疗效和安全性分析
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摘要
目的探讨华法林抗凝不同的国际标准化比值区间对保持血液透析患者长期导管通畅的疗效和安全性分析。方法将2013年1月～2017年1月期间在我院接受血液透析治疗留置长期透析导管的45例患者作为研究对象,按照治疗方法不同分为三组,其中低国际标准化比值组和高国际标准化比值组均口服使用华法林,低国际标准化比值组,国际比值维持在1.5～2.0,高国际标准化比值组,国际比值维持在2.1～3.0,对照组口服阿司匹林进行治疗。干预18个月后,对比三组导管通畅情况和不良反应情况。结果三组患者导管通畅率方面对比,低国际标准化比值组通常率最佳,与高国际标准化比值组对比无明显差异(P>0.05),两组导管通畅率均优于对照组,差异有统计学意义(P<0.05)。三组并发症发生率方面对比,低国际标准化比值组并发症发生率最低,分别低于高国际标准化比值组和对照组,差异具有统计学意义(P<0.05)。结论建议接受血液透析治疗留置长期透析导管患者使用华法林抗凝治疗时使用低国际标准化比值(维持在1.5～2.0),导管通畅率及安全性较高,应在临床中广泛使用。
Objective To investigate the efficacy and safety of different international normalized ratio interval of warfarin anticoagulation in maintaining long-term catheter patency in hemodialysis patients. Methods 45 patients with long-term dialysis catheter who underwent hemodialysis treatment from January 2013 to January 2017 were enrolled in the study objects. They were divided into three groups according to different treatment methods. Among them, low international normalized ratio group and high international normalized ratio group both used oral warfarin. The international ratio of low international normalized ratio group maintained at 1.5 to 2.0, and the international ratio of the high international normalized ratio group maintained at 2.1 to 3.0. The control group received oral aspirin for treatment. After 18 months of intervention, the catheter patency and adverse reactions of three groups were compared. Results In the comparison of the catheter patency rates of the three groups, the catheter patency rate of low international normalized ratio group was usually the best, which had no significant difference compared with that of the high international normalized ratio group(P>0.05). The catheter patency rates of the two groups were better than those of the control group, and the difference was significant(P<0.05). In the comparison of the incidence of complications in the three groups, the incidence of complications was lowest in the low international normalized ratio group, which was lower than that in the high international normalized ratio group and the control group, and the difference was statistically significant(P<0.05).Conclusion It is recommended to maintain the low international normalized ratio at 1.5 to 2.0 when using warfarin anticoagulant therapy for the treatment of patients with long-term dialysis catheter who receive hemodialysis. The catheter patency and safety is high. It should be widely used in clinic.
Objective To investigate the efficacy and safety of different international normalized ratio interval of warfarin anticoagulation in maintaining long-term catheter patency in hemodialysis patients. Methods 45 patients with long-term dialysis catheter who underwent hemodialysis treatment from January 2013 to January 2017 were enrolled in the study objects. They were divided into three groups according to different treatment methods. Among them, low international normalized ratio group and high international normalized ratio group both used oral warfarin. The international ratio of low international normalized ratio group maintained at 1.5 to 2.0, and the international ratio of the high international normalized ratio group maintained at 2.1 to 3.0. The control group received oral aspirin for treatment. After 18 months of intervention, the catheter patency and adverse reactions of three groups were compared. Results In the comparison of the catheter patency rates of the three groups, the catheter patency rate of low international normalized ratio group was usually the best, which had no significant difference compared with that of the high international normalized ratio group(P>0.05). The catheter patency rates of the two groups were better than those of the control group, and the difference was significant(P<0.05). In the comparison of the incidence of complications in the three groups, the incidence of complications was lowest in the low international normalized ratio group, which was lower than that in the high international normalized ratio group and the control group, and the difference was statistically significant(P<0.05).Conclusion It is recommended to maintain the low international normalized ratio at 1.5 to 2.0 when using warfarin anticoagulant therapy for the treatment of patients with long-term dialysis catheter who receive hemodialysis. The catheter patency and safety is high. It should be widely used in clinic.
引文
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[15]武丽锳,刘荣玲,阮明珠,等.医师-药师协作在服用华法林患者管理模式中药师工作的价值探讨[J].医药前沿,2017,7(11):111-112.
[16]许珍珍.长期服用华法林患者围手术期抗凝治疗与药学监护分析[J].海峡药学,2017,29(9):145-146.
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[18]顾欣,孙安修,张新江,等.服用华法林患者用药合理性、安全性和依从性评价[J].中国药物警戒,2016,13(12):753-756.
[19]张春燕,任晓蕾,张斌,等.华法林相关肾病患者的药学监护[J].医药导报,2017,36(8):937-939.
[20]吴癑,徐航,彭燕,等.长期服用华法林患者围手术期抗凝治疗分析及药学监护[J].安徽医药,2016,20(2):393-397.
[2]蔡晓青,徐玉兰,陈天新,等.华法林和拜阿司匹林在维持血液透析长期导管通畅中的作用比较[J].浙江临床医学,2017,19(2):210-212.
[3]刘焕皓,吕宇基,聂雨,等.华法林和阿司匹林预防血液透析长期静脉留置导管血栓栓塞的研究[J].右江民族医学院学报,2016,38(5):478-481.
[4]张继国,卢正华,彭浩,等.血液透析患者长期导管留置给予华法林干预效果评价[J].中外医学研究,2015,13(34):49-50.
[5]张蓉.行血液透析的心房颤动患者应谨慎使用华法林[J]中华医学信息导报,2017,(16):8-8.
[6]田永霞,马长红,赵明明,等.抗凝治疗对合并心房颤动的老年血液透析患者脑卒中发生的影响[J].中华老年心脑血管病杂志,2016,18(4):388-390.
[7]蔡晓青,刘毅.华法林在维持血液透析长期留置导管通畅中的作用[J].中国血液净化,2013,12(1):50-52.
[8]蔡瑜玮,王亚平,屠益微,等.肾病血液透析患者中心静脉置管血栓及纤维鞘形成的护理研究[J].中国现代医生,2017,55(12):153-156.
[8]何云霞,向倩,周颖,等.华法林在肾病住院患者中的用药分析[J].中国临床药理学杂志,2017,33(3):226-228.
[10]王恒进,李楠,刘金春,等.不同抗血栓药物防治半永久性留置导管功能不良的效果比较[J].中国综合临床,2015,31(9):791-795.
[11]邱海燕.药师干预对华法林抗凝患者治疗认知度的影响研究[J].蛇志,2017,29(3):315-316.
[12]郑淑红.疾病管理对服用华法林患者的意义[J].心理医生,2016,22(23):14-16.
[13]李玲玲,李莹,都丽萍,等.我院服用华法林患者抗凝治疗质量评价[J].中国药房,2016,27(15):2032-2034.
[14]孙彬,孙琦,高宇,等.服用华法林患者住院期间用药的合理性分析[J].中国医药指南,2018,2(8):11-15.
[15]武丽锳,刘荣玲,阮明珠,等.医师-药师协作在服用华法林患者管理模式中药师工作的价值探讨[J].医药前沿,2017,7(11):111-112.
[16]许珍珍.长期服用华法林患者围手术期抗凝治疗与药学监护分析[J].海峡药学,2017,29(9):145-146.
[17]崔素荣,梁晓凤,孟爱荣.口服华法林患者自我护理体验的质性研究[J].世界中医药,2017,(a01):216-216.
[18]顾欣,孙安修,张新江,等.服用华法林患者用药合理性、安全性和依从性评价[J].中国药物警戒,2016,13(12):753-756.
[19]张春燕,任晓蕾,张斌,等.华法林相关肾病患者的药学监护[J].医药导报,2017,36(8):937-939.
[20]吴癑,徐航,彭燕,等.长期服用华法林患者围手术期抗凝治疗分析及药学监护[J].安徽医药,2016,20(2):393-397.