2021 年第 9 期 第 16 卷

心脏机械瓣置换术后患者华法林服药依从性的影响因素分析

Related factors of warfarin medication adherence in patients after cardiac mechanical valve replacement

作者：胡文琳钱逸琼徐娟黄燕

英文作者：Hu Wenlin Qian Yiqiong Xu Juan Huang Yan

单位：上海长海医院心血管外科200433

英文单位：Department of Cardiovascular Surgery Changhai Hospital of Shanghai Shanghai 200433 China

关键词：机械瓣置换；华法林；服药依从性；影响因素

英文关键词：Mechanicalvalvereplacement;Warfarin;Medicationadherence;Influencingfactors

• 摘要：

• 目的 调查心脏机械瓣置换术后患者出院后华法林服药依从性水平并分析其影响因素。方法 选取2018年2月至2019年2月上海长海医院心血管外科收治并顺利出院的364例机械瓣置换术患者作为研究对象，采用自制的一般资料调查问卷收集患者信息，有效问卷337份。应用中文修订版Morisky服药依从性量表-8评估患者华法林服药依从性并采用单因素和多元逐步回归方法分析其影响因素。结果 337例患者华法林服药依从性总分为（7.2±0.7）分，其中依从性高者占30.0%（101例）、依从性中等者占65.6%（221例）、依从性低者占4.5%（15例）。机械瓣置换术后患者华法林服药依从性与年龄、人均月收入、文化程度、医疗支付方式、术后时间和本人是否接受过抗凝健康教育有关（均P＜0.05）。多元逐步回归分析结果显示，文化程度、人均月收入及本人是否接受过抗凝健康教育是机械瓣置换术后患者华法林服药依从性的影响因素（t=4.352、2.084、2.359，均P＜0.05）。结论 65.6%的心脏机械瓣置换术后患者华法林服药依从性处于中等水平，仍有较大提升空间。文化程度和人均月收入高以及接受过抗凝健康教育的患者服药依从性高。

• Objective To investigate the warfarin medication adherence level in patients who discharged after cardiac mechanical valve replacement and to analyze its influencing factors. Methods From February 2018 to February 2019, 364 patients undergoing cardiac mechanical valve replacement and uneventfully discharging from Changhai Hospital of Shanghai were enrolled. The self-made general information questionnaire to collect patients′ information, and 337 questionnaires were valid. The Chinese revision Morisky medication adherence scale-8 was used to assess warfarin medication adherence of patients and its influencing factors were analyzed by univariate and multivariate stepwise regression method. Results The total scores of warfarin medication adherence of 337 patients were (7.2±0.7), of which the high adherence accounted for 30.0% (101 cases), the medium adherence accounted for 65.6% (221 cases), and the low adherence accounted for 4.5% (15 cases). Age, average income per month, degree of education, medical payment method, postoperative time and whether patients received anticoagulant health related education were related to warfarin medication adherence in patients undergoing cardiac mechanical valve replacement（all P＜0.05）. Multivariate stepwise regression analysis showed that degree of education, average income per month and whether patients received anticoagulant health related education were the influencing factors of warfarin medication adherence in patients undergoing cardiac mechanical valve replacement（t=4.352, 2.084, 2.359, all P＜0.05）. Conclusions The warfarin medication adherence of 65.6% patients after mechanical valve replacement is at a moderate level, but there is still room for improvement. Patients with high degree of education and high average income per month, and receiving anticoagulant health related education have the high medication adherence.