房颤相关卒中长期抗凝的依从性研究

发布时间：2019-01-05 00:18

【摘要】：目的：1、本研究通过给予神经内科医生房颤相关卒中抗凝知识培训,了解神经内科医生在知识培训前后抗凝知识结构以及房颤相关病人抗凝率的变化。2、探讨8个条目(Morisky Medication Adherence Scale, MMAS-8)-中文修订版Morisky服药依从性量表对于发生心源性脑栓塞后使用华法林抗凝的房颤患者的信效度和适用性。方法：1、随机选取扬州地区4家医院中的2家作为培训组,当中神经内科医生共25名,其它2家作为对照组,其中共有神经内科医生23名。采用前瞻性队列研究方法,干预组给予为期六个月的抗凝知识专项培训。培训形式主要为理论知识培训,内容包含两部分：第一部分为抗凝的必要性、抗凝注意事项以及如何有效提高患者抗凝依从性,降低抗凝脱落率的具体措施,观察培训前后抗凝率的变化等知识培训；第二部分为有关抗凝方面的房颤患者病例分析以及教学查房,以问卷考核的方式了解培训前后神经内科医生知识结构变化,观察并分析抗凝率的变化。2、采用方便抽样的方法,选取2014年6月1日至2015年05月31日于扬州市第一人民医院神经内科收治的发生心源性脑栓塞后使用华法林的房颤患者122例。采用门诊随访的方式对使用华法林抗凝的房颤患者以中文修订版MMAS-8为研究工具收集资料,采用信度分析、因子分析及相关分析等评价量表信效度。结果：1、①对照组与干预组之间的基线资料比较：学历、职称和性别无显著性差异(P均0.05),对照组与干预组有关抗凝知识考核差异无统计学意义(P0.05),对干预组予抗凝知识培训后,较之对照组,干预组抗凝知识考核有明显变化(P=0.000),干预组在抗凝知识培训前后抗凝知识考核分有明显变化(P=0.000)。②干预组在抗凝知识专项培训后各职称医师提高幅度为：初级中级高级职称医师。③抗凝率比较：抗凝培训前,对照组、干预组之间抗凝率无差别(P=0.744),抗凝培训后,干预组抗凝率比对照组增高明显(p=0.044)。组内抗凝率分析：干预组在理论培训后(P=0.049)抗凝率比较有统计学意义(P0.05)；对照组在干预组抗凝理论培训前后抗凝率比较无统计学意义(P0.05)。2、中文版MMAS-8的Cornbach,s％系数为0.61,评定者间的一致性系数为0.91,重测系数为0.92,量表表面效度为1.009,不同等级服药依从性患者的抗凝控制和抗凝并发症发生率比较,差异有统计学意义(P0.05,P0.01)。结论：1、对神经内科医生进行抗凝知识培训,在完善其抗凝知识结构的同时,房颤相关卒中的抗凝率也得到了提高。。2、中文版MMAS-8信度和效度较好,可用于评估发生心源性脑栓塞后使用华法林的房颤患者的用药依从性。
[Abstract]:Objective: 1. To understand the changes of anticoagulant knowledge structure and anticoagulant rate of patients with atrial fibrillation before and after training in neurologist by training neurologists on anticoagulant knowledge of atrial fibrillation related apoplexy. To explore the reliability, validity and applicability of 8-item (Morisky Medication Adherence Scale, MMAS-8) -Chinese revised version of Morisky compliance scale for patients with atrial fibrillation treated with warfarin after cardiogenic cerebral embolism. Methods: 1. 2 out of 4 hospitals in Yangzhou were randomly selected as training group, among them 25 neurologists and 2 others as control group, among which 23 were neurologists. A prospective cohort study was used and the intervention group was given six months of specific training in anticoagulant knowledge. The training form is mainly theoretical knowledge training. The content includes two parts: the first part is the necessity of anticoagulant, the precautions of anticoagulant and the concrete measures how to improve patients' anticoagulant compliance effectively and reduce the rate of anticoagulant fall off. Observe the change of anticoagulant rate before and after training and other knowledge training; The second part is the case analysis and teaching rounds of patients with atrial fibrillation related to anticoagulant. The changes of knowledge structure of neurologist before and after training were investigated by questionnaire, and the changes of anticoagulant rate were observed and analyzed. From June 1, 2014 to May 31, 2015, 122 patients with atrial fibrillation treated with warfarin after cardiogenic cerebral embolism in Department of Neurology, first people's Hospital of Yangzhou City were selected. The data of patients with atrial fibrillation treated with warfarin anticoagulant were collected with Chinese revised MMAS-8 as the research tool. Reliability analysis, factor analysis and correlation analysis were used to evaluate the reliability and validity of the scale. Results: 1 comparison of baseline data between control group and intervention group: there was no significant difference in educational background, professional title and sex (P 0.05), but there was no significant difference between control group and intervention group in examination of anticoagulant knowledge (P0.05). After training the anticoagulant knowledge in the intervention group, there were significant changes in the evaluation of anticoagulant knowledge in the intervention group compared with the control group (P0. 000). The test scores of anticoagulant knowledge before and after the training of anticoagulant knowledge in the intervention group were obviously changed (P0. 000). 2 after the special training of anti-coagulant knowledge in the intervention group, the improvement range of doctors with different titles was as follows: junior middle and senior professional doctors. 3. Anticoagulant rate Comparison: before anticoagulant training, There was no difference in anticoagulant rate between the control group and the intervention group (P0. 744). After anticoagulant training, the anticoagulant rate in the intervention group was significantly higher than that in the control group (p0. 044). Analysis of anticoagulant rate in group: after theoretical training (P0. 049), the anticoagulant rate of intervention group was statistically significant (P0.05); There was no significant difference in anticoagulant rate between the control group and the intervention group before and after the training of anticoagulant theory (P0.05). The Cornbach,s% coefficient of the Chinese version of MMAS-8 was 0.61, the consistency coefficient of the evaluation group was 0.91, the retest coefficient was 0.92, and the control group had no statistical significance before and after training (P0.05). The apparent validity of the scale was 1.009. There were significant differences in the incidence of anticoagulant control and anticoagulant complications among patients with different grades of drug compliance (P0.05P 0.01). Conclusion: 1. The anticoagulant rate of atrial fibrillation related stroke was improved by training neurologists with anticoagulant knowledge. The reliability and validity of Chinese version of MMAS-8 were better. It can be used to evaluate the compliance of patients with atrial fibrillation treated with warfarin after cardiogenic cerebral embolism.
【学位授予单位】：扬州大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R743.3;R541.75

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