诚信声明我声明，所呈交的毕业论文（设计）是本人在老师指导下进行的研究工作及取得的研究成果。据我查证，除了文中特别加以标注和致谢的地方外，论文（设计)中不包含其他人已经发表或撰写过的研究成果，也不包含为获得其他教育机构的学位或证书而使用过的材料。我承诺，论文（设计）中的所有内容均真实、可信。毕业论文（设计）作者（签名）：年月日换瓣病人术后服用华法林抗凝情况调查【摘要】目的：探究进行过瓣膜置换术的病人在临床药师干预下服用华法林进行抗凝的情况，为临床安全运用华法林提供参考。方法：①纳入符合标准、无用药禁忌的瓣膜置换术后服用华法林的患者，随机将患者分为两个大组，分别为干预组和对照组：②对干预组进行药学监护、用药宣教和每日观察干预组T-NR和各项能反应华法林抗凝效果的指标值并进行药学方面的建议等临床药师干预措施，而对非干预组则不进行以上措施：③对所有纳入的病人进行基本信息查询和搜集，如对性别、年龄、现病史、个人史、家族史和手术方式等信息进行搜集：④所有患者随访3个月，收集特定天数的TNR值，以及各项能反应华法林抗凝效果的指标值，例如：血浆凝血酶原时间、活化部分凝血活酶时间和凝血酶原活动度等：⑤比较两组术后服用华法林治疗三个月后NR达到1.8-2.5治疗范围的时间(TTR)百分比、一般TTR≥85%时服用华法林预防栓塞的疗效才能体现出来；TBR:统计NR>3的百分数：TAR:统计NR<2的百分数；以及一些出血事件的差异。结果：两组基线特征比较差异无统计学意义(P>0.05)；在干预组与对照组的TTR比较中，两组间有显著性差异(P<0.05),干预组(52.00%)的TTR值较对照组(36.00%)明显升高；比较两组的达到稳定NR范围的时间、NR>3的比例、出血概率，两组间存在显著差异(P<0.05),干预组明显低于对照组。结论：瓣膜置换病人术后在临床药师干预下服用华法林的抗凝预后情况更好。【关键词】华法林：心脏瓣膜置换手术：T-NR:TTR:出血事件Investigation of Warfarin Anticoagulation after ValveReplacement[Abstract]Objective:To explore the situation of warfarin anticoagulation inpatients with valve replacement under the intervention of clinical pharmacists,and toprovide reference for the safe use of warfarin in clinical practice.Methods:1Patients who met the criteria and took warfarin after valve replacement without drugcontraindications were included and randomly divided into control group andintervention group.(2)Medication guidance,medication education and dailyobservation of PT-INR and all indexes reflecting the anticoagulant effect of warfarinin the intervention group were given clinical pharmacists intervention measures,whilethe non-intervention group was not given the above measures;3 The basicinformation of all patients was queried and collected,such as gender,age,presentmedical history,personal history,family history and surgical methods.(4)All patientswere followed up for 3 months,and PT-INR values of specific days were collected,aswell as indexes reflecting the anticoagulant effect of warfarin,such as plasmaprothrombin time,activated partial thrombin time and prothrombin activity,etc.5Only by comparing the percentage of time (TTR)when INR reached the treatmentrange of 1.8-2.5 after three months of postoperative warfarin treatment between thetwo groups,and when TTR85%,can the effect of warfarin prevention of embolismbe reflected;TBR:statistics of the percentage of INR>3;TAR:statistics of thepercentage of INR<2;And some differences in bleeding events.Results:There wasno significant difference in baseline characteristics between the two groups (P>0.05).The TTR value of the intervention group (52.00%)was significantly higher than thatof the traditional group (36.00%),and the difference between the two groups wasstatistically significant (P <0.05).Compared with the two groups,the time to reachthe stable INR range,the proportion of INR>3 and the probability of bleeding,Therewere significant differences between the two groups (P<0.05),with the interventiongroup significantly lower than the control group.Conclusion:The anticoagulant