机械瓣膜置换术后患者抗凝药物使用依从性的研究进展

doi:10.3761/j.issn.1672-9234.2021.10.017

摘要/Abstract

摘要：

合理使用抗凝药物是预防机械瓣膜置换术后并发症的关键环节,而用药依从性是评价患者遵医嘱规定用药程度的主要指标之一。因此,该文对机械瓣膜置换术后患者抗凝药物使用依从性的评价工具、影响因素进行综述,建议合理调整给药方案,加强个体化健康教育;规范线下随访制度与流程,建立完善的社会支持系统;积极开发智能辅助软件,科学开展延续性护理,为居家康复治疗、延续性护理及开展相关研究提供参考。

关键词: 心脏瓣膜假体植入, 服药依从性, 康复护理, 综述

Abstract:

The rational use of anticoagulant drugs is important for preventing complications after mechanical valve replacement,and medication compliance is one of the main indicators to evaluate the degree of patient compliance with the prescribed medication. This paper reviewed the assessment tools,influencing factors of medication adherence in patients after mechanical valve replacement to provide reference. It is recommended to rationally adjust the dosing regimen,strengthen individualized health education,standardize the offline follow-up system and process,establish a complete social support system,actively develop intelligent auxiliary software,and scientifically carry out continuous nursing so as to provide reference for home rehabilitation treatment,continuation care and related research.

Key words: Heart Valve Prosthesis Implantation, Medication Adherence, Rehabilitation Nursing, Review

郑小源,刘佳欣,唐璟,黄卓尔,刘莉娟,丛丽. 机械瓣膜置换术后患者抗凝药物使用依从性的研究进展[J]. 中华护理教育, 2021, 18(10): 946-950.

ZHENG Xiao-yuan,LIU Jia-xin,TANG Jing,HUANG Zhuo-er,LIU Li-juan,CONG Li. Anticoagulant medication adherence in patients after mechanical valve replacement：a review[J]. Chinese Journal of Nursing Education, 2021, 18(10): 946-950.

参考文献 26

[1]	王增武, 胡盛寿. 《中国心血管健康与疾病报告2019》要点解读[J]. 中国心血管杂志, 2020, 25(5):401-410.
	Wang ZW, Hu SS. Interpretation of report on cardiovascular health and diseases in China 2019[J]. Chin J Cardiovasc Med, 2020, 25(5):401-410.
[2]	Baumgartner H, Falk V, Bax JJ, et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease[J]. Eur Heart J, 2017, 38(36):2739-2791. doi: 10.1093/eurheartj/ehx391 pmid: 28886619
[3]	陆洋, 傅巧美. 心脏瓣膜置换术后患者抗凝治疗依从性的调查分析[J]. 解放军护理杂志, 2016, 33(8):62-64.
	Lu Y, Fu QM. Investigation and analysis of the compliance of anticoagulant therapy for patients underwent cardiac valve replacement[J]. Nurs J Chin PLA, 2016, 33(8):62-64.
[4]	Kini V, HO PM. Interventions to improve medication adhere-nce:a review[J]. JAMA, 2018, 320(23):2461-2473. doi: 10.1001/jama.2018.19271
[5]	Morisky DE, Ang A, Krousel-Wood M, et al. Predictive validity of a medication adherence measure in an outpatient setting[J]. J Clin Hypertens(Greenwich), 2008, 10(5):348-354.
[6]	司在霞, 郭灵霞, 周敏, 等. 修订版Morisky服药依从性量表用于抗凝治疗患者的信效度检测[J]. 护理学杂志, 2012, 27(22):23-26.
	Si ZX, Guo LX, Zhou M, et al. Reliability and validity of the modified Morisky Medication Adherence Scale applied to patients on warfarin therapy after mechanical heart-valve replacement[J]. J Nurs Sci, 2012, 27(22):23-26.
[7]	任红艳, 郭玉颖, 郭明华, 等. 下肢深静脉血栓清除术后患者服药信念与抗凝治疗依从性相关性分析[J]. 护理学报, 2019, 26(17):37-40.
	Ren HY, Guo YY, Guo MH, et al. Association between medication belief and compliance of anticoagulant therapy of patients after elimination of lower-limb deep venous thrombosis[J]. J Nurs(China), 2019, 26(17):37-40.
[8]	Nie B, Chapman SCE, Chen Z, et al. Utilization of the beliefs about medicine questionnaire and prediction of medication adherence in China:a systematic review and meta-analysis[J]. J Psychosom Res, 2019, 122:54-68. doi: S0022-3999(18)30975-9 pmid: 31006535
[9]	Horne R, Weinman J, Hankins M. The beliefs about medicines questionnaire:the development and evaluation of a new method for assessing the cognitive representation of medication[J]. Psychol Health, 1999, 14(1):1-24. doi: 10.1080/08870449908407311
[10]	司在霞, 周敏, 曹广庆, 等. 中文版服药信念特异性问卷用于换瓣术后抗凝患者的信效度检验[J]. 护理学杂志, 2013, 28(4):20-23.
	Si ZX, Zhou M, Cao GQ, et al. Reliability and validity of the Chinese version of Beliefs about Medicines Questionnaire-Specific among patients on warfarin therapy after mechanical heart-valve replacement[J]. J Nurs Sci, 2013, 28(4):20-23.
[11]	Forbes CA, Deshpande S, Sorio-Vilela F, et al. A systematic literature review comparing methods for the measurement of patient persistence and adherence[J]. Curr Med Res Opin, 2018, 34(9):1613-1625. doi: 10.1080/03007995.2018.1477747 pmid: 29770718
[12]	Sattler ELP, Lee JS, Perri M. Medication(re) fill adherence measures derived from pharmacy claims data in older Americans:a review of the literature[J]. Drugs Aging, 2013, 30(6):383-399. doi: 10.1007/s40266-013-0074-z
[13]	Mehta SJ, Asch DA, Troxel AB, et al. Comparison of pharmacy claims and electronic pill bottles for measurement of medication adherence among myocardial infarction patients[J]. Med Care, 2019, 57(2):e9-e14. doi: 10.1097/MLR.0000000000000950
[14]	朱丽, 陈莹莹, 罗亮春, 等. 心脏瓣膜置换术后患者抗凝治疗的个案管理[J]. 护理学杂志, 2015, 30(16):27-29.
	Zhu L, Chen YY, Luo LC, et al. Case management of patients receiving anticoagulation therapy after heart valve replacement[J]. J Nurs Sci, 2015, 30(16):27-29.
[15]	Onundarson PT, Flygenring B. Oral anticoagulant monitoring:are we on the right track?[J]. Int J Lab Hematol, 41(S1):40-48. doi: 10.1111/ijlh.2019.41.issue-S1
[16]	Perreault S, de Denus S, White-Guay B, et al. Oral anticoagulant prescription trends,profile use,and determinants of adherence in patients with atrial fibrillation[J]. Pharmacotherapy, 2020, 40(8):40-54. DOI: 10.1002/phar.2350. doi: 10.1002/phar.2350
[17]	Talana AS, Huber K, Sorin M, et al. Patient-level adherence and interventions in an interdisciplinary DOAC clinic[J]. Thromb Res, 2019, 179:34-36. doi: S0049-3848(19)30214-2 pmid: 31075700
[18]	Vaanholt MCW, Weernink MGM, von Birgelen C, et al. Perceived advantages and disadvantages of oral anticoagulants,and the trade-offs patients make in choosing anticoagulant therapy and adhering to their drug regimen[J]. Patient Educ Couns, 2018, 101(11):1982-1989. doi: S0738-3991(18)30319-7 pmid: 30001822
[19]	吕姗姗. 心脏瓣膜置换术后患者自我管理行为及影响因素[D]. 济南:山东大学, 2016.
	Lü SS. Study on related factors with oral warfarin adherence of postoperative patients of mechanical heart valve replacement[D]. Jinan:Shandong University, 2016.
[20]	Abdou JK, Auyeung V, Patel JP, et al. Adherence to long-term anticoagulation treatment,what is known and what the future might hold[J]. Br J Haematol, 2016, 174(1):30-42. doi: 10.1111/bjh.2016.174.issue-1
[21]	Wang X, Xu B, Liang H, et al. Distribution characteristics and factors influencing oral warfarin adherence in patients after heart valve replacement[J]. Patient Prefer Adherence, 2018, 12:1641-1648. doi: 10.2147/PPA
[22]	杨懿人. 心脏机械瓣置换术后患者口服华法林依从性的相关因素研究[D]. 郑州:郑州大学, 2019.
	Yang YR. Study on related factors with oral warfarin adherence of postoperative patients of mechanical heart valve replacement[D]. Zhengzhou:Zhengzhou University, 2019.
[23]	Fredericks S, Yau T. Clinical effectiveness of individual patient education in heart surgery patients:a systematic review and meta-analysis[J]. Int J Nurs Stud, 2017, 65:44-53. doi: S0020-7489(16)30210-3 pmid: 27842225
[24]	杨梦娇, 陈蓉, 王亚莉. 标准化随访流程对心脏机械瓣膜置换术后患者自我管理行为的影响[J]. 中国医药导报, 2019, 16(2):102-105.
	Yang MJ, Chen R, Wang YL. Influence of standardized follow-up procedures on self-management behavior of post-operative patients with mechanical heart valve replacement[J]. Chin Med Herald, 2019, 16(2):102-105.
[25]	杨梦娇, 陈蓉, 王亚莉. 人工心脏瓣膜置换术后康复期患者抗凝治疗监测社区数据库的建设与实践[J]. 中华现代护理杂志, 2018, 24(27):3267-3271.
	Yang MJ, Chen R, Wang YL. Construction and practice of community database of anticoagulant therapy monitoring for patients in convalescence after artificial cardiac valve replacement[J]. Chin J Mod Nurs, 2018, 24(27):3267-3271.
[26]	Morawski K, Ghazinouri R, Krumme A, et al. Association of a smartphone application with medication adherence and blood pressure control[J]. JAMA Intern Med, 2018, 178(6):802-809. doi: 10.1001/jamainternmed.2018.0447 pmid: 29710289