腹壁注射低分子肝素按压时间与皮下出血关系的临床研究

胡倩　王琴　孙国珍　陈月香　张敏　陶源　田金萍

[摘要] 目的 探索腹壁注射低分子肝素后不同按压时间与皮下出血发生情况的关系，为规范注射后按压时间提供依据。方法 整群选择2014年9—11月该院心血管内科病房接受低分子肝素注射的患者101例，采取自身对照法，每例患者分别接受4种不同按压时间的注射，即不按压、按压3 min、按压5 min和按压10 min。由专人统一操作，12 h后观察皮下出血发生情况。 结果 101例患者按不按压或按压时间分为4组，4组按压方式的出血发生率为22.7%～28.51%，组间比较差异无统计学意义（χ2=3.39， P>0.05）。另外注射后皮下出血面积数据为非正态分布，进行非参数检验，结果示出血面积的组间比较差异无统计学意义（H=0.368，P>0.05）。结论 采用规范的腹壁注射方法，不按压不会增加皮下出血的发生。推荐不按压，以减轻患者及护理工作负担。

[关键词] 低分子肝素；腹壁注射；按压时间；皮下出血

[中图分类号] R472 [文献标识码] A [文章编号] 1674-0742（2015）12（a）-0043-03

[Abstract] Objective To discuss the relationship between the different pressing times after abdominal injection of low molecular weight heparin and the incidence of subcutaneous hemorrhage and provide the basis for regulating the pressing time after injection. Methods 101 patients receiving low molecular weight heparin injection in cardiovascular medicine from September 2014 to November 2014 were selected and each patient respectively received 4 kinds of injection with different pressing times， namely， no pressing， 3 minutes' pressing， 5 minutes' pressing and 10 minutes' pressing， which were uniformly operated by specially-assigned persons， after 12 h， the incidence of subcutaneous hemorrhage was observed. Results 101 cases were divided into four groups according to the pressing time， the incidence of hemorrhage of the 4 groups ranged from 22.7% to 28.51%， the comparison between the 4 groups was not statistically significant（χ2=3.39， P>0.05）， in addition， after injection， subcutaneous bleeding area data were abnormal distribution， non-parametric test results showed that the comparison of bleeding area between the 4 groups was not statistically significant （H=0.368， P>0.05）. Conclusion No pressing can't increase the incidence of subcutaneous hemorrhage by adopting standard method of abdominal wall injection， and no pressing is recommended in order to reduce the burden on patients and nursing work.

[Key words] Low molecular heparin； Abdominal injection； Pressing time； Subcutaneous hemorrhage

低分子肝素是目前临床使用十分广泛的一种新型抗血栓剂，在心血管内科常被用于不稳定型心绞痛、急性心肌梗死、PCI术后、房间隔缺损介入封堵术后等患者。由于其具有抗凝作用，患者凝血功能下降及皮下注射时刺破血管等原因，低分子肝素注射可引起局部出血和疼痛，甚至是皮下血肿[1]。国内外学者一直在努力研究和改进低分子肝素的注射方法，以减少皮下出血的发生。经文献查阅，腹壁注射低分子肝素的方法已基本形成共识[2-4]，但注射后按压时间尚未统一，主要有4种建议，即不按压、按压3 min、按压5 min、按压10 min以上[5-8]。这些研究……