心脏机械瓣膜置换术后病人抗凝治疗满意度的影响因素研究

目的:调查心脏机械瓣膜置换术(mechanical heart valve replacement,MHVR)术后长期抗凝治疗病人的满意度,并分析其影响因素,为临床治疗提供依据。方法:采用方便抽样的方法选取贵州省某三级甲等医院MHVR术后146例病人为研究对象,采用中文版抗凝治疗满意度量表(Anti-Clot Treatment Scale,ACTS)对其抗凝治疗满意度进行调查,采用单因素、多元逐步回归分析对抗凝治疗满意度的影响因素进行分析。结果:多元逐步回归分析结果显示,影响MHVR术后病人抗凝治疗满意度的因素从大到小依次为出院后并发症发生情况、出院时长、医生能否调华法林剂量、出院后是否再次住院以及每次复查费用,可以解释满意度总变异的58.7%。标准化回归方程为满意度得分=0.262×出院时长-0.347×出院后并发症发生情况+0.239×医生能否调华法林剂量-0.219×出院后是否再次住院-0.130×每次复查费用。结论:对MHVR术后病人进行延续性护理时,应重点加强华法林用药的教育,提高用药依从性,严禁病人随意加量或减量,指导病人观察出血、血栓形成的信号,学会应对措施,同时及时告知医生,减少并发症的发生。

Study on influencing factors of patients' satisfaction with anticoagulant therapy after mechanical heart valve replacement

Objective:To investigate the satisfaction of patients with long-term anticoagulant therapy after mechanical heart valve replacement(MHVR),and analyze the influencing factors,so as to provide basis for clinical treatment.Methods:A total of 146 patients were selected as the research objects by using Convenience sampling method after MHVR surgery in a third grade A hospital in Guizhou Province.Chinese version of Anti-Clot Treatment Scale(ACTS)was used to investigate their satisfaction with anticoagulant treatment.Single factor analysis and multiple stepwise regression analysis were used to analyze the influencing factors of satisfaction with anticoagulant therapy.Results:The results of multiple stepwise regression analysis showed that the factors influencing patients'satisfaction with anticoagulant therapy after MHVR from large to small were the occurrence of complications after discharge,the length of discharge,whether doctors could adjust warfarin dose,whether hospitalized again after discharge,and the cost of each reexamination,which could explain 60.1%of the total variation of satisfaction.The regression equation was satisfaction score=0.262×the length of discharge-0.347×the occurrence of complications after discharge+0.239×whether doctors could adjust warfarin dose-0.219×whether hospitalized again after discharge-0.130×the cost of each reexamination.Conclusions:When continuing care for MHVR patients after surgery,we should focus on strengthening warfarin medication education,improve medication compliance,strictly prohibit patients to increase or decrease dosage at will,guide patients to observe the signals of bleeding and thrombosis,learn to cope with measures,and inform doctors in time to reduce complications.