臺灣博碩士論文加值系統

中文摘要
可邁丁(商品名Coumadin®，成分名Warfarin) 為最常用於降低血栓性疾病的口服抗凝血劑，但因其劑量調整不易，且易產生嚴重之副作用(出血和栓塞)，故其安全性及有效性值得研究及探討。本篇研究報告，將門診病人分為兩組，一部份由藥師進行衛教(實驗組)，一部分未進行衛教(對照組)。實驗组在進行6個月的追蹤後，和對照組一起進行問卷調查。結果顯示，服用口服抗凝血藥物Coumadin的病人，於門診接受過藥師的口頭衛教之後，知道Coumadin的作用以及忘記服藥的處置，均較未接受衛教組的為高，且有統計學上顯著的差異。另外，病患知道定期抽血的重要性、知道規律服藥及回診的重要性、知道飲酒或運動對於Coumadin的影響以及知道哪些食物對於Coumadin有影響的比例雖較未接受衛教組高，但並未具統計學上的差異。在副作用的發生情形，接受衛教組發生不良反應之比例較未接受組低。
台灣不像國外擁有一套完善的抗凝血劑藥事服務 (anticoagulation management service)，雖然本研究僅是做單純的衛教介入，但是整體而言，我們的研究結果顯示，有接受衛教的病人於整體積分比未接受衛教的病人較佳（t＝-1.968；p = 0.055），雖然本實驗結果未達顯著效益，這可能是病人樣本數目較少的緣故；本研究證實衛教模式在臨床上對病人確實有其效果，且具有不錯的品質，確保病患在接受過用藥指導後，能夠對自己身體的狀況以及所服用的藥物有更進一步的了解，進而可以提高服藥順從性以及降低副作用的發生率。

目次
致謝 I
目次 III
中文摘要 VII
英文摘要 IX
表目錄 XI
圖目錄 XIII
第一章 前言 1
第一節 前言 1
第二節 口服抗凝血劑治療 1
第三節 藥師在口服抗凝血劑治療的角色 3
第二章 材料與方法 5
第一節 研究對象及方法 5
第二節 藥師執行抗凝血藥事照顧的方法 6
第三節 研究流程 9
第三章 文獻探討 10
第一節 WARFARIN總論 10
一. 簡介 10
二. 臨床用途及適應症, 11
三. 藥理作用機轉,, 11
四. 藥物動力學參數15, 13
五. 監測參數 14
六. INR值升高之處理原則15, 17
七. 用法及劑量15,16 18
八. 影響抗凝血之因素 19
九. 副作用15 23
十. 過量及毒性處理 24
十一. 病患須知15 24
第二節 抗凝血劑藥事服務 25
一. 抗凝血劑藥事服務簡介 25
二. 抗凝血劑藥事服務成果 26
第四章 結果與分析 28
第一節 有衛教病患基本資料統計 28
第二節 問卷基本資料統計 31
一. A院有接受衛教病患基本資料統計 31
二. A院無接受衛教病患基本資料統計 35
三. B院無接受衛教病患基本資料統計 39
四. 三組納入者不良反應一覽表 43
第三節 問卷結果與分析 44
一. 教育程度和coumadin基本知識的關連性 44
二. 年齡和coumadin基本知識的關連性 47
三. 是否接受過藥師衛教和coumadin基本知識的關連性 50
四. A院和B院的比較 51
第五章 討論 55
第一節 研究討論 55
一. 淺談抗凝血劑 55
二. 東方人的優勢與INR 57
三. 問卷結果與討論(年齡) 60
四. 問卷結果與討論(教育程度) 65
五. 問卷結果與討論(有無接受用藥指導) 69
六. 基因對抗凝血劑的影響 80
七. 電話追蹤評值的適當性 81
八. 未來努力方向 82
第二節 研究限制 83
一. 研究設計 83
二. 研究地點 84
三. 研究流程 84
四. 成效測量 84
五. 問卷部份 85
六. 資料獲取方式 86
七. INR數值測量 86
第六章 結論 89
參考文獻 90

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