中国典型病例大全

目的 探讨风险护理应用于使用华法林抗凝治疗的阵发性心房颤动(paroxysmal auricular fibrillation,PAF)患者的价值。方法 选择2023年1月—2024年12月天津医科大学附属宝坻医院就诊并接受华法林抗凝的62例PAF患者，信封法随机分为对照组和研究组，各31例，两组华法林使用信息相同。其中对照组提供常规护理，研究组予以常规护理联合风险护理，比较两组华法林使用情况[国际标准化比值(international nor-malized ratio,INR)处于目标范围内的时间百分比(time in therapeutic range,TTR)、定期监测INR占比等]、血栓栓塞发生率及出血事件(皮下出血、牙龈出血等)发生率等。结果 研究组TTR高于对照组(t=7.395,P<0.001)，定期监测INR占比(96.77%)高于对照组(74.19%)(χ²=6.369,P=0.012)；血栓栓塞发生率(0)显著低于对照组(19.35%)(χ²=6.643,P=0.010)；牙龈出血、黏膜出血发生率均低于对照组(χ²=8.434、6.613,P=0.004、0.010)；两组消化道出血、皮下出血发生率对比，无统计学意义(χ²=1.449、0.350,P=0.229、0.554)。结论 针对使用华法林抗凝的PAF患者实施风险护理有效性、安全性均较优，有利于提高TTR及定期监测INR占比，同时能够有效降低血栓栓塞、出血事件发生率。

Objective To explore the value of risk nursing in patients with paroxysmal atrial fibrillation(PAF)treated with warfarin anticoagulation therapy. Methods 62 patients with PAF who received warfarin anticoagulation at Baodi Hospital affiliated to Tianjin Medical University from January 2023 to December 2024were selected. They were randomly divided into a control group and a study group using envelope method, with 31 patients in each group. The warfarin use information was the same in both groups. The control group received routine care, while the study group received routine care combined with risk care. The use of warfarin between the two groups was compared, including the percentage of time in therapeutic range(TTR)when the international normalized ratio(INR)was within the target range, the proportion of INR monitored regularly, the incidence of thromboembolism, and the incidence of bleeding events(subcutaneous bleeding, gingival bleeding, etc.). The TTR of the study group was higher than that of the control group(t=7.395,P<0.001), and the proportion of INR monitored regularly(96.77%)was higher than that of the control group(74.19%)(χ²=6.369,P=0.012);The incidence of thromboembolism(0)was significantly lower than that of the control group(19.35%)(χ²=6.643,P=0.010); The incidence of gingival bleeding and mucosal bleeding was lower in the control group than in the control group(χ²=8.434、6.613,P=0.004、0.010); There was no statistically significant difference in the incidence of gastrointestinal bleeding and subcutaneous bleeding between the two groups (χ²=1.449、0.350,P=0.229、0.554). Conclusion The implementation of risk nursing for PAF patients using warfarin anticoagulation is effective and safe, which is beneficial for improving TTR and regularly monitoring the proportion of INR. At the same time, it can effectively reduce the incidence of thromboembolism and bleeding events.