Amiri Mina, Kargar Marzieh, Borhanihaghighi Afshin, Soltani Fahimeh, Zare Najafe
PHD Candidate, Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran.
Community Based Psychiatric Care Research Center, Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran.
Appl Nurs Res. 2017 Feb;33:96-101. doi: 10.1016/j.apnr.2016.10.008. Epub 2016 Oct 18.
The current study is designed in order to investigate the effect of nurse-led care (the supportive and educational measurements by nurses) on stability time in therapeutic range of INR in ischemic stroke patients receiving Warfarin.
In this quasi-experimental study, 80 ischemic stroke patients were investigated, 40 patients in experimental group and 40 in the control group referred to the nurse-based warfarin clinics affiliated to Shiraz University of Medical Sciences. The mean±SD duration of the intervention was 144±84days. The patients based on the percentage stability time in the therapeutic range of INR were classified into 3 groups of good control (>75%), medium control (60-75%), and poor control groups (<60%). The results were analyzed using qui-square and independent t-test according to these categories.
38 patients in the experimental group and 39 in the control group had the therapeutic range of INR 2-3. The percentage of the stability time in the therapeutic range of INR (mean±SD) in the experimental group was 64.08%±18.7 and in the control group it was 44.58%±25.12 (P<0.001). The percentage of total INRs within the therapeutic range was 52.5% in the experimental group and 40.6% in the control group (P=0.001).
In conclusion, using the stroke prevention guidelines, thrombotic therapy protocols and familiarity with patients' diagnosis and risk factors in the experimental group led to more patients' stability time (The time that patients could remain stable within the INR therapeutic range) in their therapeutic range of INR as the best indicator of clinical performance.
本研究旨在调查护士主导的护理（护士提供的支持性和教育性措施）对接受华法林治疗的缺血性中风患者国际标准化比值（INR）在治疗范围内的稳定时间的影响。
在这项准实验研究中，对80例缺血性中风患者进行了调查，其中40例患者为实验组，40例为对照组，这些患者均前往设拉子医科大学下属的以护士为主导的华法林诊所就诊。干预的平均±标准差持续时间为144±84天。根据INR治疗范围内的稳定时间百分比，将患者分为3组：良好控制组（>75%）、中等控制组（60-75%）和差控制组（<60%）。根据这些分类，使用卡方检验和独立t检验对结果进行分析。
实验组38例患者和对照组39例患者的INR治疗范围为2-3。实验组INR治疗范围内稳定时间的百分比（平均±标准差）为64.08%±18.7，对照组为44.58%±25.12（P<0.001）。实验组治疗范围内INR总数的百分比为52.5%，对照组为40.6%（P=0.001）。
总之，在实验组中，使用中风预防指南、血栓形成治疗方案以及熟悉患者的诊断和危险因素，使得更多患者在其INR治疗范围内的稳定时间（患者能够在INR治疗范围内保持稳定的时间）作为临床疗效的最佳指标得以延长。
