建立心房顫動病人口服抗凝血藥之臨床照護指引

Establishment of Oral Anticoagulants Clinical Care Guideline for Atrial fibrillation Patients

黃照雲(Chao-Yun Huang) ； 黃筠家(Yun-Chia Huang)

《醫學與健康期刊》 10卷3期 (2021/11) Pp. 47-61

摘要

心房顫動誘發缺血性腦中風導致的失能程度較嚴重、且死亡率較高，建議病人應使用口服抗凝血藥治療。本指引藉由實證模式建立心房顫動病人口服抗凝血藥之臨床照護指引。本指引以四階段進行，1.照護指引工作小組的籌組及運作；2.搜尋2013至2020年實證文獻，收錄臨床指引文獻及隨機對照試驗共10篇，作為指引發展依據；3.舉辦專家焦點團體會議，邀請12位照護專家檢定照護指引之效度；4.以問卷調查照護專家及臨床護理師照護指引之可行性。結果確認本指引為五個構面共36項，包括臨床診斷6項、評估方法2項、治療處置8項、持續評估6項、護理策略14項。本指引可提供專科護理師及臨床護理師對心房顫動病人口服抗凝血藥之評估及護理策略，以期提升照護品質。

關鍵字

心房顫動 ； 口服抗凝血藥 ； 照護指引

並列摘要

Atrial fibrillation is a key risk factor for ischemic stroke. Poor control of atrial fibrillation may lead to severe disability and high mortality. This study established clinical practice guidelines for oral anticoagulant therapy in patients with atrial fibrillation through an evidence-based method. These guidelines were established in four stages. The first stage involved building a project team. In the second stage, the literature review, 10 articles on clinical guidelines and randomized controlled trials from 2013 to 2020 were reviewed. In the third stage, a structured face-to-face meeting with 12 experts was held, to validate the guidelines from a professional perspective. In the fourth stage, a questionnaire was administered to the experts and 50 nurses to survey their opinions, and the guidelines were revised and finalized. Comprising 5 dimensions with 36 items, (6 clinical diagnoses, 2 evaluation methods, 8 treatments, 6 continuous assessments, and 14 nursing strategies), these guidelines provide nurse practitioners and nurses with effective clinical assessment strategies, to improve the quality of health care.

並列關鍵字

Atrial fibrillation ； Oral anticoagulant ； Practice guidelines

參考文獻

台灣腦中風學會：腦中風危險因子防治指引：心房纖維顫動2016。取自：https://www.stroke.org.tw/GoWeb2/include/getfile.php?file=f01&KeyID=1429656755f1681255f204。引用7/1/ 2018。Taiwan Stroke Society: Guideline for Prevention of Stroke in Patients with Atrial Fibrillation 2016. Available at: https://www.stroke.org.tw/GoWeb2/include/getfile.php?file=f01&KeyID=1429656755f1681255f204. Accessed July 1, 2018. [In Chinese]

Chiang CE, Wang KL, Lin SJ: Asian strategy for stroke prevention in atrial fibrillation. Europace 2015;17:31-9.

January CT, Wann LS, Calkins H, et al.: 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients with Atrial Fibrillation : A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guide-lines and the Heart Rhythm Society in Collaboration With the Society of Thoracic Surgeons. Circulation 2019;140: 125-51.

劉家昌、林益卿、黃馨葆：新型口服抗凝血藥物在預防心纖維顫動患者中風預防的使用。家庭醫學與基層醫療 2013；32：314-21。Liu JC, Lin YQ, Huang XB: The use of new oral anti-coagulant drugs in the prevention of stroke in patients with heart fibrillation. Family Medicine & Primary Medical Care 2013;32:314-21. [In Chinese]

Brouwers MC, Kho ME, Browman GP, et al.: Appraisal of Guidelines for Research & Evaluation II 2017. Available at: https://drive.google.Com/drive/my-drive?hl=zh-TW. Accessed August 12, 2018.