华法林应用初期inr变化的分析-心血管内科专业论文.docxVIP

学位论文声明 学位论文声明 愿将本学位论文向社会公开，接受社会监督与指导，同时 愿将其转交中国学术期刊(光盘版)电子杂志社，同意该社将 其收录在《中国优秀博硕士学位论文数据库》，供社会各界检索、 参考。 学位申请人意见：同意 学位申请人签字：杨帆 签字时间：二00四年三月 导师意见： 同意 导师签字：刘晓惠 签字时间：二00四年三月 首都医科大学硕士研究生论文中文摘要 首都医科大学硕士研究生论文 中文摘要 华法林开始应用初期INR变化的分析 目的：观察非瓣膜病房颤患者应用不同起始剂量华法林治疗 后INR的变化趋势，比较两组在不同时间的达标率、药物调整期 间出血并发症的发生率、平均维持剂量及INR达稳定状态的时间 差异。 方法：入选具有华法林抗凝适应证的非瓣膜病房颤患者53 例，随机分为2组，分别以5reed日或3rag／日华法林起始治疗，于 第3、4、5、8天测定INR，根据第1NR调整服药剂量，直到INR 稳定。 结果：与3rag／日组相比，5mg／日组INR速度变化较快、幅度 较大，两组第3、4、8天INR的达标率、达标时间有显著性差异 (P0．05)，虽然两组第5天的达标率没有达到统计学意义 rp=0．354)，但5rag／日组达标率(35．7％)有高于3mg／目组(24％) 的趋势。5rag／日组INR达稳定时间缩短(10．5+--2．5天和12．2+-2．9 天，p=0．03)，出血并发症并不增加。 结论：5 mg／日起始，连续4天的华法林滴定方案能使INR迅 速、安全、有效地达到稳定，出血并发症的发生并不增加。 关键词：非瓣膜病房颤，华法林，INR 首都医科大学硕士研究生论文Abstract 首都医科大学硕士研究生论文 Abstract Analyis of INR Change with Warfarin Initial Therapy object：To observe tNR change with different initial warfarin dose，and to compare the proportion of INR within therapy range， the time that the INR was stabilized，and the episodes of bleeding during the dose adjustment； Method：53 patients with nonvalvular atrial fibrillation(NVAF) who had the indication of anticoagulation therapy were recruited，and were randomly assigned to different warfarin dose groups(3mg／d or 5mg／d)．Before the treatment，determined the INR on day 3嘲、4恤、5”、 8“， adjusted the following dose of warfarin according to the INR，until the INR was stabilized； Result：In comparison with 3mg／d group，INR changes in 5mg／d group were more quickly．and me ranges were broader． Between two groups，there was significantly difference of the ratios that INR was within target range and the time that INR was starIilized at target range on day 4th and day 8”．Although there was nonsignificant difference ofratiothattheINRWithintarget range between the two groups on day 5，there was a tendency of higher ratio in 5mg／d group．The time of INR stabilized at target range were shorter in 5mg／d group compared with the 3mg／d group(10．5±2．5 days vsl2．2±2．9 days，p=O．03)，without increasing the episodes of bleeding