| 陈婕,赵春艳,胡旖玟,张莉.社区医护人员对房颤抗凝知识掌握现况及影响因素研究[J].上海护理,2022,22(S1): |
| 社区医护人员对房颤抗凝知识掌握现况及影响因素研究 |
| 1. Ward 16F, Dongfang Hospital Affiliated to Tongji University (expo garden area), Shanghai 200123, Tel.: 13671979909;2. Nursing Department of Dongfang Hospital Affiliated to Tongji University; |
| DOI： |
| 中文关键词: 社区医护人员 房颤 抗凝 知识 影响因素 |
| 英文关键词:community medical staff Atrial fibrillation Anticoagulation Knowledge influence factor |
| 基金项目: |
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| 中文摘要: |
| 目的 社区医护人员对房颤抗凝相关知识掌握情况,分析了影响房颤抗凝的主要问题,为进一步加强规范化抗凝质量管理提供理论依据。方法 本研究为多中心横断面调查,2022 年1月,采用方便抽样的方法,选取浦东新区心房颤动 (专病) 联盟范围内的47家社区卫生服务中心医护人员,于当日对医护人员进行调查。本研究应用自制问卷,调查形式为通过问卷星进行线上数据收集。问卷由5名心律失常专家和2名心血管内科护士长基于文献研究和对医护人员进行心房颤动抗凝相关内容半结构化访谈的基础上制定,问卷内容主要包括问卷内容包括医护人员对房颤患者缺血性脑卒中抗凝的风险评估、抗凝药物 (维生素拮抗剂和非维生素拮抗剂) 相关因素的影响、抗凝并发症的观察和处理、抗凝监测的维度。采用EpiData3.1软件对数据进行统计学处理,采用SPSS 21.0软件进行统计学处理。结果 本研究共发放问卷有效问卷538份,对抗凝管理相关知识评分 (13.36 ± 2.47) 分,合格率为51.3%。调查显示,85% 以上的掌握率为: CHA2DS2-VASC 评分、HAS-BLED 评分、维生素 K 拮抗剂药代动力学特点、不良反应观察部位。掌握率低于50% 的分别是达比加群酯肌酐清除率的选择、NOAC治疗患者出血类型、NOAC轻微出血处理、NOAC非危及生命的大出血处理、NOAC危及生命或关键部位出血。 单因素分析结果显示,专业、职称、学历、工作年限、参加相关培训、房颤患者照顾者对房颤抗凝知识掌握水平差异均有统计学意义(P＜ 0.05)。多因素Logistic回归分析结果显示,专业、职称、学历、工作年限、参加相关培训是社区医护人员房颤抗凝知识掌握情况的主要影响因素(P＜0.05)。结论 社区医护人员对房颤抗凝知识掌握情况欠缺,需要对房颤患者缺血性脑卒中抗凝的风险评估、抗凝药物 (维生素拮抗剂和非维生素拮抗剂) 相关因素的影响、抗凝并发症的观察和处理、抗凝监测的维度相关知识的培训。 |
| 英文摘要: |
| Objective To analyze the main problems affecting the anticoagulation of atrial fibrillation, and to provide a theoretical basis for further strengthening the standardized anticoagulation quality management. Methods this study was a multi center cross-sectional survey. In January 2022, the medical staff of 47 community health service centers within the scope of atrial fibrillation (specialized disease) alliance in Pudong New Area were selected by convenient sampling to investigate the medical staff on the same day. In this study, a self-made questionnaire was used to collect online data. The questionnaire was developed by 5 arrhythmia experts and 2 head nurses of cardiovascular medicine based on literature research and semi-structured interviews with medical staff on atrial fibrillation anticoagulation. The contents of the questionnaire mainly include medical staff"s risk assessment of ischemic stroke anticoagulation in patients with atrial fibrillation The influence of related factors of anticoagulant drugs (vitamin antagonists and non vitamin antagonists), the observation and treatment of anticoagulant complications, and the dimension of anticoagulant monitoring. Epidata3 The data were statistically processed by SPSS 21.0 software. Results 538 valid questionnaires were distributed in this study. The score of anticoagulant management related knowledge was (13.36 ± 2.47), and the qualified rate was 51.3%. The survey showed that the mastery rate of more than 85% was cha2ds2-vasc score, has-bled score, pharmacokinetic characteristics of vitamin K antagonists and observation sites of adverse reactions. The mastery rate of less than 50% were the selection of dabigatran ester creatinine clearance rate, the type of bleeding in patients treated with noac, noac slight bleeding treatment, noac non life-threatening massive bleeding treatment, noac life-threatening or key site bleeding. The results of univariate analysis showed that there were significant differences in specialty, professional title, education, working years, participation in relevant training and the mastery level of anticoagulant knowledge of patients with atrial fibrillation (P < 0.05). The results of multivariate logistic regression analysis showed that major, professional title, educational background, working years and participation in relevant training were the main influencing factors on the mastery of atrial fibrillation anticoagulation knowledge by community medical staff (P < 0.05). Conclusion community medical staff lack the knowledge of anticoagulation in patients with atrial fibrillation. They need to be trained in the risk assessment of anticoagulation in patients with ischemic stroke, the influence of anticoagulant drugs (vitamin antagonists and non vitamin antagonists), the observation and treatment of anticoagulant complications, and the dimension of anticoagulant monitoring. |
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