老年心脏瓣膜置换术后患者抗凝治疗依从性调查及其预后因素分析

Investigation of compliance with anticoagulant therapy and analysis of prognostic factors in elderly patients after cardiac valve replacement

中文关键词: 老年  心脏瓣膜置换术  抗凝治疗  心功能  心脏射血分数  依从性  预后  影响因素

英文关键词: elderly  cardiac valve replacement  anticoagulant therapy  cardiac function  cardiac ejection fraction  com-pliance  prognosis  influencing factor

中文摘要:

      目的 调查老年心脏瓣膜置换术后患者的抗凝治疗依从性现状,并分析患者预后相关影响因素.方法 回顾性分析2020年6月-2023年4月西京医院收治的符合调查标准的239例行心脏瓣膜置换术老年患者的临床资料,收集患者的一般资料,调查患者术后抗凝治疗依从性及预后情况,根据患者预后情况分为预后良好组(n=171例)和预后不良组(n=68例),分析心脏瓣膜置换术后患者的抗凝治疗期间预后的影响因素.结果 本研究239例心脏瓣膜置换术后患者中抗凝治疗依从性良好97例,依从性不良为142例,依从率为40.48％;相较于大专以上文化程度、居住地在城市、家庭月收入水平≥3 000元的心脏瓣膜置换术后抗凝治疗患者,文化程度高中及以下、居住在农村、家庭月收入水平＜3 000元的心脏瓣膜置换术后患者抗凝治疗依从性差者占比更大(P＜0.05);预后不良组的术前心功能分级Ⅲ～Ⅳ级、体外循环时间≥160 min、动脉阻断时间≥120 min、术后射血分数≤40％、抗凝治疗依从性差的占比均高于预后良好组(P＜0.05);术前心功能分级Ⅲ～Ⅳ级、体外循环时间≥160 min、动脉阻断时间≥120 min、术后射血分数≤40％为造成心脏瓣膜置换手术患者预后不良的危险因素(P＜0.05),而抗凝治疗依从性良好为心脏瓣膜置换手术患者预后的保护因素(P＜0.05).结论 老年心脏瓣膜置换术后患者的抗凝治疗依从性一般,患者依从性与其文化程度、居住地、家庭月收入水平等有关,而患者的术前心功能分级、体外循环时间、动脉阻断时间、术后射血分数、抗凝治疗依从性等可能为影响其预后的相关因素.

英文摘要:

      Objective To investigate the compliance of anticoagulant therapy in elderly patients after cardiac valve re-placement and analyze the related influencing factors of prognosis.Methods The clinical data of 239 elderly patients undergo-ing cardiac valve replacement in Xijing Hospital from June 2020 to April 2023 were retrospectively analyzed.Their general data were collected,and the compliance of postoperative anticoagulant therapy and prognosis were investigated.According to their prognosis status,they were divided into good prognosis group(n=171)and poor prognosis group(n=68).The influencing factors of prognosis during anticoagulant therapy after cardiac valve replacement were analyzed.Results Among 239 patients after cardiac valve replacement,there were 97 cases with good anticoagulant therapy compliance,142 ones with poor compli-ance,and the compliance rate was 40.48％.Compared with patients with education level of junior college or above,living in urban areas,and family monthly income level ≥ 3 000 yuan,patients with education level of senior high school or below,liv-ing in rural areas and family monthly income level＜3 000 yuan had a higher proportion of poor anticoagulant therapy compli-ance after cardiac valve replacement(P＜0.05).The proportions of patients with preoperative cardiac function grade Ⅲ～Ⅳ,cardiopulmonary bypass time≥ 160 min,arterial clamping time≥120 min,postoperative ejection fraction ≤ 40％and poor an-ticoagulant therapy compliance in the poor prognosis group were significantly higher than those in the good prognosis group(P＜0.05).The preoperative cardiac function grade Ⅲ～Ⅳ,cardiopulmonary bypass time≥160 min,arterial clamping time≥120 min,and postoperative ejection fraction ≤ 40％were the risk factors for poor prognosis(P＜0.05),while the good com-pliance of anticoagulant therapy was a protective factor for the prognosis of patients after cardiac valve replacement(P＜0.05).Conclusion The compliance of anticoagulant therapy in elderly patients after cardiac valve replacement is general.Their com-pliance is related to their education level,place of residence,family monthly income level and etc.The preoperative cardiac function grading,cardiopulmonary bypass time,arterial clamping time,postoperative ejection fraction and anticoagulant thera-py compliance may be the relevant factors affecting the prognosis of patients.