中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

心脏机械瓣膜置换术后抗凝治疗远程管理:前瞻性队列研究

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目的 探讨应用基于互联网+移动 APP 对心脏机械瓣膜置换术后口服华法林抗凝治疗稳定患者进行远程管理的安全性和有效性。 方法 本课题为前瞻性队列研究,根据纳入排除标准纳入 2017 年 1~12 月期间在我院行心脏机械瓣膜置换术后半年以上且在门诊接受口服华法林抗凝治疗的患者 80 例。根据患者意愿和当地医院 INR 监测条件分为远程组(40 例、应用互联网+移动 APP 进行管理)与对照组(40 例、门诊行抗凝管理)。分别完成 12 个月抗凝随访,比较两组临床效果。 结果 抗凝随访期间,两组患者国际标准化比值(international normalized ratio,INR)实测值差异无统计学意义(P=0.732)。远程组的 INR 监测平均间隔时间为 3~65(21.4±12.5)d,对照组患者的监测平均间隔时间为 7~93(39.6±14.7)d(P=0.012)。对照组和远程管组的治疗范围时间(time in therapeutic rang,TTR)分别是 42.7%(6 027.6 d/14 116.0 d)、64.8%(10 168.6 d/14 972.0 d),(P=0.018)。两组 INR 的治疗范围时间分数(fraction in therapeutic range,FTTR)分别是 45.6%(144 次/316 次)、67.1%(432 次/644 次,P=0.015)。80 例患者在 12 个月随访期间均无严重血栓栓塞及出血事件发生。两组间抗凝相关总并发症、一般性出血和栓塞发生率差异无统计学意义(P>0.05)。 结论 对于符合远程管理条件的心脏机械瓣膜置换术后抗凝稳定的患者,应用基于互联网+移动 APP 进行远程管理安全有效。远程管理能够增加抗凝监测频率,且在不增加抗凝治疗风险的基础上能够获得更方便、快速的复诊咨询,节省时间及经济成本,提高生活质量,患者满意度高。

Objective To explore the safety and efficacy of mobile APP in telemanagement for patients who received oral warfarin anticoagulant therapy after mechanical heart valve replacement. Methods A prospective cohort study was performed. According to the inclusion and exclusion criteria, a total of 80 patients who underwent mechanical heart valve replacement for more than half a year and received oral warfarin anticoagulant therapy in outpatient department were included in our hospital from January 1, 2017 to December 31, 2017. These patients were divided into a telemanagement group (40 paitents, telemanagement using mobile APP) and control group (40 patients, anticoagulant management in outpatient clinics) according to patients' wishes and local hospital INR monitoring conditions. After 12-month follow-up, clinical effect of the two groups were compared. of the international normalized ratio (INR), time in therapeutic rang (TTR), Fraction in therapeutic range (FTTR), anticoagulation-related complications and patient satisfaction were analyzed. Results During the follow-up period of anticoagulation, there was no significant difference in international normalized ratio (INR) between the two groups (P=0.732). The average interval of INR monitoring in the telemanagement group was 3-65 days (21.4 ± 12.5), while that in the control group was 7-93 days (39.6 ± 14.7) days (P=0.012). therapeutic rang (TTR) was 42.7% (6 027.6 d/14 116.0 d) in the control group and 64.8% (10 168.6 d/14 972.0 d) in the telemanagement group (P=0.018). And the fraction in therapeutic range (FTTR) in the two groups was 45.6% (144/316) and 67.1% (432/644), respectively (P= 0.015). No serious thromboembolism or hemorrhage events occurred in the 80 patients during the 12-month follow-up period. There was no significant difference in the incidence of anticoagulation-related complications, general bleeding and embolism between the two groups (P>0.05). Conclusion For patients with stable anticoagulation after cardiac mechanical valve replacement, it is safe and effective to telemanagement by mobile APP. Telemanagement can increase the frequency of anticoagulation monitoring without increasing anticoagulation risk, meanwhile, it also could obtaining more convenient and rapid consultation, saving time and economic costs, improving the quality of life and patient satisfaction.

关键词: 心脏瓣膜置换术; 抗凝治疗; 远程管理; 治疗范围时间; 治疗范围时间分数

Key words: Heart valve replacement; anticoagulant therapy; telemanagement; time in therapeutic rang; fraction in therapeutic range

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