不同剂量低分子肝素封管液用于老年浅静脉留置的效果观察

任红英 邓晓东 任燕萍

【摘要】 目的 觀察不同剂量低分子肝素封管液用于老年浅静脉留置的临床效果。方法 120例使用浅静脉留置针的老年患者， 采用随机数字表法分为Ⅰ、Ⅱ、Ⅲ、Ⅳ组， 每组30例。Ⅰ组采用低分子肝素盐水封管液 10 ml（低分子肝素 10 U/ml） 进行封管， Ⅱ组采用低分子肝素盐水封管液5 ml（低分子肝素20 U/ml）进行封管， Ⅲ组采用低分子肝素盐水封管液5 ml（低分子肝素10 U/ml）进行封管， Ⅳ组采用生理盐水封管液10 ml进行封管。比较四组患者置管前后血小板（PLT）、凝血酶原时间（PT）、国际标准化比值（INR）不同时间段留置针最大流速， 留置针不良事件发生情况。结果 置管前、拔管24 h后， 四组患者的PLT、INR、PT水平比较， 差异均无统计学意义（P>0.05）。第1、2天， 四组患者的留置针最大流速比较， 差异均无统计学意义（P>0.05）;第3天， Ⅰ组及Ⅱ组患者的留置针最大流速高于Ⅲ组;第4天， Ⅰ组及Ⅱ组患者的留置针最大流速高于Ⅲ组及Ⅳ组;第5、6、7天， Ⅰ组及Ⅱ组患者的留置针最大流速高于Ⅲ组及Ⅳ组， Ⅰ组患者的留置针最大流速高于Ⅱ组， 差异均具有统计学意义（P<0.05）。四组患者均未发生皮下血肿。四组患者的液体渗出、穿刺部位感染发生率比较， 差异均无统计学意义（P>0.05）;Ⅲ组、Ⅳ组患者的静脉炎及留置针堵塞发生率分别为13.3%、13.3%及13.3%、13.3%， 均高于Ⅰ组、Ⅱ组的0、3.3%及0、3.3%， 差异均具有统计学意义（P<0.05）;Ⅰ组及Ⅱ组、Ⅲ组及Ⅳ组患者的静脉炎、留置针堵塞发生率比较， 差异均无统计学意义（P>0.05）。结论 低分子肝素盐水封管液10 ml（低分子肝素10 U/ml）更适合无肝素使用禁忌的老年浅静脉留置管理。

【关键词】 低分子肝素;浅静脉留置;封管护理管理

DOI：10.14163/j.cnki.11-5547/r.2020.21.049

Observation on the effect of different doses of low molecular weight heparin tube-sealing solution for superficial vein indwelling   REN Hong-ying， DENG Xiao-dong， REN Yan-ping. Department of Rehabilitation， Wuxi Rehabilitation Hospital， Wuxi 214043， China

【Abstract】 Objective   To observe the clinical effect of different doses  of low molecular weight heparin tube-sealing solution for superficial vein indwelling. Methods   A total of 120 elderly patients with superficial vein indwelling were divided into group Ⅰ， Ⅱ， Ⅲ and Ⅳ by random numerical table， with 30 cases in each group. GroupⅠ received 10 ml of low molecular weight heparin tube-sealing fluid （10 U/ml）， Group Ⅱ received 5 ml of low molecular weight heparin tube sealing fluid（20 U/ml）， group Ⅲ received 5 ml of low molecular weight heparin tube sealing fluid（10 U/ml）， and group Ⅳ received 10 ml of 0.9% normal saline tube-sealing fluid. The platelet （PLT）， prothrombin time （PT）， international normalized ratio （INR）， maximum flow rate of indwelling needle， occurrence of adverse events of indwelling needle were compared among the four groups. Results   Before intubation and 24 h after extubation， there was no statistically significant difference in levels of PLT， INR and PT among the four groups （P>0.05）. On the 1st and 2nd day， there was no statistically significant difference in the maximum flow rate of indwelling needle among the four groups （P>0.05）. On 3rd day， the maximum flow rate of indwelling needle of group Ⅰ and group Ⅱ was higher than that of group Ⅲ. On 4th day， the maximum flow rate of indwelling needle of group Ⅰ and group Ⅱ was higher than that of group Ⅲ and group Ⅳ. On 5th， 6th and 7th day， the maximum flow rate of indwelling needle of group Ⅰ and group Ⅱ was higher than that of group Ⅲ and group Ⅳ， and the maximum flow rate of indwelling needle of group Ⅰ was higher than that of group Ⅱ. The difference was statistically significant （P<0.05）. None of the four groups developed subcutaneous hematoma. There was no statistically significant difference in incidence of fluid exudation and infection of puncture site among the four groups （P>0.05）. The incidence of phlebitis and blocked indwelling needle of group Ⅲ and group Ⅳ were 13.3%， 13.3% and 13.3%， 13.3% respectively， which were all higher than those of group Ⅰ and group Ⅱ 0， 3.3% and 0， 3.3%， and the difference was statistically significant （P<0.05）. There was no statistically significant difference in incidence of phlebitis and blocked indwelling needle between group Ⅰ and group Ⅱ， group Ⅲ and group Ⅳ （P>0.05）. Conclusion   Low molecular weight heparin tube-sealing fluid 10 ml （10 U/ml） is more suitable for the elderly superficial vein indwelling without heparin contraindications.

【Key words】 Low molecular weight heparin; Superficial vein indwelling; Tube-sealing nursing and management

浅静脉留置针主要用于间歇性、连续性静脉输液治疗。因有多种不同的规格产品可选择， 相关的穿刺技术容易学习， 避免每天穿刺， 从而减轻患者痛苦， 提高护士工作效率和患者满意度等， 在临床广泛应用。浅静脉留……