高龄非瓣膜性心房颤动患者新型口服抗凝药依从性分析

doi:10.11958/20250024

摘要/Abstract

摘要：

目的探究高龄非瓣膜性心房颤动（NVAF）患者新型口服抗凝药（NOACs）服药依从性的影响因素及与社会支持的相关性。方法便利抽样法选择2022年1月—2024年1月在安徽省六安市人民医院接受NOACs治疗的126例NVAF患者临床资料。收集患者一般资料，根据Morisky服药依从性量表评分将患者分为依从性良好组和依从性较差组，社会支持评定量表（SSRS）调查社会支持情况，比较依从性良好组和依从性较差组患者一般资料，使用Pearson相关分析服药依从性与社会支持的关系，多因素Logistic回归分析患者服药依从性的影响因素。结果依从性良好组（74例）和依从性较差组（52例）受教育程度、伴焦虑情绪和伴抑郁情绪患者占比、CHA₂DS₂-VASc评分、HAS-BLED评分及SSRS评分差异均有统计学意义（P<0.05）。Pearson相关性分析结果显示，患者服药依从性与客观支持（r=0.461）、主观支持（r=0.432）、支持利用度（r=0.323）及SSRS评分（r=0.596）均呈正相关（P<0.05）。多因素Logistic回归分析结果显示，受教育程度低、伴焦虑情绪、低HAS-BLED和SSRS评分是高龄NVAF患者服药依从性较差的危险因素（P<0.05）。结论提高高龄NVAF患者的社会支持水平有利于患者形成良好的服药依从性。

关键词: 心房颤动, 华法林, 服药依从性, 社会支持, 老年人

Abstract:

Objective To explore the influencing factors of compliance with new oral anticoagulants (NOACs) in elderly patients with nonvalvular atrial fibrillation (NVAF) and its correlation with social support. Methods The clinical data of 126 patients with NVAF treated by NOACs in Lu 'an People's Hospital of Anhui Province from January 2022 to January 2024 were selected by convenient sampling method. General data of patients were collected. According to Morisky medication compliance scale, patients were divided into two groups: the good compliance group (n=74) and the poor compliance group (n=52). Social support was investigated by Social Support Rating Scale (SSRS). General data of patients were compared between the good compliance group and the poor compliance group. The relationship between medication compliance and social support was analyzed by Pearson correlation. Multivariate Logistic regression was used to analyze the influencing factors of patient medication compliance. Results There were statistically significant differences in educational level, the proportion of patients with anxiety and depression, CHA₂DS₂-VASc score, HAS-BLED score and SSRS score between the good compliance group and the poor compliance group (P<0.05). The results of the correlation analysis showed that the medication compliance of patients was positively correlated with objective support (r=0.461), subjective support (r=0.432), support utilization (r=0.323) and SSRS score (r=0.596, P<0.05). The results of multivariate Logistic regression analysis showed that low educational level, accompanied by anxiety, low HAS-BLED and SSRS scores were risk factors for poor medication compliance in elderly NVAF patients (P<0.05). Conclusion Improving the social support level of elderly patients with NVAF is conducive to the formation of good medication compliance.

Key words: atrial fibrillation, Warfarin, medication adherence, social support, aged

中图分类号:

R541.75

图/表 3

参考文献 24

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组别		n	性别（男/女）	年龄/岁		受教育程度（初中及以下/高中及中专/大专及以上）			职业（职工/农民）		医疗费用支付方式（全部报销或部分报销/全部自费）		合并症（高血压/ 糖尿病/冠心病）
依从性良好组		74	48/26	76.31±5.29		34/29/11			25/49		62/12		33/27/14
依从性较差组		52	30/22	76.54±5.62		37/7/8			18/34		43/9		21/23/8
χ²或t			0.666	0.232		10.524^＊			0.009		0.026		0.806
组别	药物类型（直接凝血酶抑制剂/Xa因子抑制剂）				焦虑（是/否）		抑郁（是/否）	住院次数/次		CHA₂DS₂-VASc 评分/分		HAS-BLED 评分/分		SSRS评分/分
依从性良好组	33/41				32/42		24/50	2.47±0.82		3.57±1.26		3.73±1.14		38.24±9.21
依从性较差组	24/28				36/16		32/20	2.37±0.74		2.87±0.92		2.97±0.85		31.27±8.45
χ²或t	0.030				8.302^＊		10.478^＊	0.757		3.411^＊＊		4.069^＊＊		4.323^＊＊

组别		n	性别（男/女）	年龄/岁		受教育程度（初中及以下/高中及中专/大专及以上）			职业（职工/农民）		医疗费用支付方式（全部报销或部分报销/全部自费）		合并症（高血压/ 糖尿病/冠心病）
依从性良好组		74	48/26	76.31±5.29		34/29/11			25/49		62/12		33/27/14
依从性较差组		52	30/22	76.54±5.62		37/7/8			18/34		43/9		21/23/8
χ²或t			0.666	0.232		10.524^＊			0.009		0.026		0.806
组别	药物类型（直接凝血酶抑制剂/Xa因子抑制剂）				焦虑（是/否）		抑郁（是/否）	住院次数/次		CHA₂DS₂-VASc 评分/分		HAS-BLED 评分/分		SSRS评分/分
依从性良好组	33/41				32/42		24/50	2.47±0.82		3.57±1.26		3.73±1.14		38.24±9.21
依从性较差组	24/28				36/16		32/20	2.37±0.74		2.87±0.92		2.97±0.85		31.27±8.45
χ²或t	0.030				8.302^＊		10.478^＊	0.757		3.411^＊＊		4.069^＊＊		4.323^＊＊

因素	β	SE	Wald χ²	P	OR（95%CI）
受教育程度	1.048	0.441	5.650	0.017	2.853（1.202~6.770）
伴焦虑情绪	1.145	0.442	6.703	0.010	3.142（1.321~7.475）
伴抑郁情绪	0.378	0.438	0.746	0.388	1.460（0.619~3.444）
CHA₂DS₂-VASc评分	-0.019	0.255	0.006	0.939	0.981（0.596~1.615）
HAS-BLED评分	-0.530	0.254	4.359	0.037	0.589（0.358~0.968）
SSRS评分	-0.067	0.030	5.020	0.025	0.935（0.881~0.992）
常数项	2.303	1.043	4.878	0.027	10.003

因素	β	SE	Wald χ²	P	OR（95%CI）
受教育程度	1.048	0.441	5.650	0.017	2.853（1.202~6.770）
伴焦虑情绪	1.145	0.442	6.703	0.010	3.142（1.321~7.475）
伴抑郁情绪	0.378	0.438	0.746	0.388	1.460（0.619~3.444）
CHA₂DS₂-VASc评分	-0.019	0.255	0.006	0.939	0.981（0.596~1.615）
HAS-BLED评分	-0.530	0.254	4.359	0.037	0.589（0.358~0.968）
SSRS评分	-0.067	0.030	5.020	0.025	0.935（0.881~0.992）
常数项	2.303	1.043	4.878	0.027	10.003