摘要
目的 探讨老年冠心病患者皮下注射低分子肝素后是否按压与皮下出血发生率的相关性.方法 纳入 2019 年 1 月至 2021 年 12 月在南京医科大学附属南京医院行经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)后使用低分子肝素皮下注射的老年冠心病患者131 例作为研究对象,按照注射后是否按压分为观察组 67 例和对照组 64 例.皮下注射低分子肝素的流程均按照本院已纳入规范的"低分子肝素皮下注射法护理质量督查标准"执行,其中观察组要求注射完毕后按压穿刺点3～5 min,力度以皮肤下陷 1cm为准,比较两组患者皮下出血的发生率.结果 观察组皮下瘀斑发生率(9.0%)与对照组(7.8%)比较差异无统计学意义(P＞0.05),观察组皮下硬结发生率(4.5%)与对照组(1.6%)比较差异亦无统计学意义(P＞0.05).患者的年龄、性别、腹围以及体质量指数(body mass index,BMI)与注射低分子肝素后发生皮下出血没有显著相关性(P＞0.05),而腹部皮脂厚度与皮下出血存在显著相关性(P＜0.05),是预测注射低分子肝素后发生皮下出血的独立预测因子.结论 老年冠心病患者低分子肝素皮下注射后按压与出血发生率无相关性,无需按压.患者的腹部皮脂厚度是预测注射低分子肝素后发生皮下出血的独立预测因子,应通过规范操作来避免皮下出血的发生.
Abstract
Objective To investigate the correlation between the manual compression on injection point and the incidence of subcutaneous bleeding after subcutaneous injection of low molecular weight heparin(LMWH)in elderly patients with coronary artery disease.Methods A total of 131 elderly patients with coronary artery disease,who received subcutaneous injection of LMWH after percutaneous coronary intervention(PCI)at the Affiliated Nanjing Hospital of Nanjing Medical University of China between January 2019 and December 2021,were enrolled in this study.According to whether the manual compression on the injection point was employed or not after the injection of LMWH,the patients were divided into the study group(n=67)and the control group(n=64).The operation process of subcutaneous injection of LMWH was carried out in accordance with the"Supervision Standard for Nursing Quality of Hypodermic Injection of Low Molecular Weight Heparin"which was included in the norms formulated by authors'hospital.For the patients of the study group,the injection point was manually pressed for 3-5 min after the injection of LMWH,the manually-used force was to press the skin down for 1cm deep.The incidence of subcutaneous bleeding was compared between the two groups.Results In the study group and the control group,the incidence of subcutaneous ecchymosis was 9.0%and 7.8%respectively,the incidence of subcutaneous hard tubercle was 4.5%and 1.6%respectively,the differences between the two groups were not statistically significant(both P＞0.05).The patient's age,gender,abdominal circumference and body mass index(BMI)carried no obvious correlation with the subcutaneous bleeding after LMWH injection(P＞0.05),while a statistically significant correlation existed between the abdominal wall fat thickness and the subcutaneous bleeding(P＜0.05),which could be used as an independent predictor for the occurrence of subcutaneous bleeding after LMWH injection.Conclusion No obvious correlation exists between the manual compression on injection point and the incidence of subcutaneous bleeding in elderly patients with coronary artery disease after subcutaneous injection of LMWH,therefore,no compression manipulation,used as a hemostatic measure,is required after subcutaneous injection of LMWH.The abdominal wall fat thickness is an independent predictor for subcutaneous bleeding after injection of LMWH.Standard operation procedures should be strictly followed so as to avoid the occurrence of subcutaneous bleeding after injection of LMWH.(J Intervent Radiol,2024,32:77-81)
基金项目
江苏省卫生健康委科研课题(BJ19006)
南京市卫生科技发展专项资金项目(YKK19086)
南京市第一医院星火培育护理发展基金()
NETL
NSTL
万方数据