急性冠状动脉综合征患者低分子肝素注射与按压时间对其皮下出血及疼痛的影响

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摘要目的探讨急性冠状动脉综合征(acute coronary syndrome,ACS)患者低分子肝素(low molecular weight heparin, LMWH)皮下注射和按压时间对皮下出血和疼痛的影响。方法选择医院200例ACS患者,采用自身对照的类实验性研究方法,每例患者接受四种不同方法的皮下注射。方法A:注射10 s,停留10 s之后拔针,不按压;方法B:注射10 s,停留10 s之后拔针,拔针后按压5 min;方法C:注射30 s后拔针,不按压;方法D:注射30 s后拔针,拔针后按压5 min。注射完毕即刻采用视觉模拟评分(visual analogue scale ,VAS)评价注射局部疼痛程度,注射后48 h测量最大皮下出血直径。结果方法A的注射部位皮下出血发生率(40.5%)最低,与其他方法(67.0%、58.5%、58.0%)比较,差异有统计学意义(P＜0.001);四种方法的皮肤变色直径依次为(2.58±2.23)mm、(7.87±11.26)mm、(3.81±3.69)mm和(6.15±9.97)mm,A、C方法皮肤变色直径明显低于B、D方法,差异有统计学意义(P＜0.05),A与C方法之间无统计学差异。方法A的注射部位疼痛发生率(44.5%)最低,与方法B(59.5%)比较,差异有统计学意义(P＜0.05);四种方法的疼痛评分依次为(0.70±0.93)、(1.13±1.29)、(0.94±1.27)和(1.18±1.46),A方法疼痛评分明显低于B、D方法,差异有统计学意义(P＜0.05),A与C方法之间无统计学差异。结论 ACS患者进行LMWH皮下注射治疗时,采用注射10 s,停留10 s,拔针后不按压的方法,能明显降低患者注射部位皮下出血及疼痛的发生率,同时减少护士的工作量。

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关键词 ：急性冠状动脉综合征, 低分子肝素, 皮下注射, 注射时间, 按压时间, 皮下出血, 疼痛

Abstract：Objective To investigate the effect of the injection duration and pressing time of subcutaneous low molecular weight heparin on bruising and pain in patients with acute coronary syndrome (ACS) during antiplatelet therapy, and to find an effective surgical method.Methods Two hundred patients with ACS were enrolled in this study. They were administered with heparin subcutaneously, and each patient received four injections in four different ways. Way A: patients were injected for 10 s, needles were pulled out after 10 s ,and the injection areas were not pressed. Way B: patients were injected for 10 s, needles were pulled out after 10 s, and the injection areas were pressed for 5 min. Way C: patients were injected for 30 s, needles were pulled out ,and the injection areas were not pressed. Way D: patients were injected for 30 s, needles were pulled out ,and the injection areas were pressed for 5 min. The degree of pain at the injection site was evaluated with visual analogue scale (VAS) when the injection was finished, and the largest discoloration diameter was measured 48 h after injection.Results Way A’s incidence of subcutaneous bleeding(40.5%) was the lowest. Compared with other ways (67.0%, 58.5%, 58.0%), the difference was statistically significant(P<0.001).The skin discoloration diameters of the four ways were(2.58±2.23)mm,(7.87±11.26)mm,(3.81±3.69)mm and(6.15±9.97)mm respectively. The skin discoloration diameter of Way A and C was significantly smaller than that of B and D, and the difference was statistically significant(P<0.05). There was no statistically significant difference between Way A and C. Way A’s pain rate (44.5%) was the lowest. Compared with Way B (59.5%), the difference was statistically significant (P<0.05). The pain scores of the four ways were (0.70±0.93), (1.13±1.29), (0.94±1.27) and (1.18±1.46) respectively. The pain score of Way A was significantly lower than that of B and D, and the difference was statistically significant (P<0.05).There was no statistically significant difference between A and C.Conclusions When needles are pulled out,and the injection areas are not pressed after the patients with acute coronary syndrome are injected for 10 s, the bruising and pain of patients can be reduced, so can the workload of the nurses.

Key words： acute coronary syndrome low molecular weight heparin subcutaneous injection injection duration pressing time bruising pain

收稿日期: 2017-11-06

ZTFLH:

R473.5

基金资助:武警总医院课题基金(WZ2015025)

作者简介: 沈志奇,本科学历,副主任护师,护士长。

引用本文:

沈志奇, 石欢, 马蕊, 张玉珍, 孙滕伟. 急性冠状动脉综合征患者低分子肝素注射与按压时间对其皮下出血及疼痛的影响[J]. 武警医学, 2018, 29(3): 253-256. SHEN Zhiqi, SHI Huan, MA Rui, ZHANG Yuzhen, SUN Tengwei. Effect of injection duration and pressing time of subcutaneous low molecular weight heparin on bruising and pain in patients with acute coronary syndrome. Med. J. Chin. Peop. Armed Poli. Forc., 2018, 29(3): 253-256.

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http://journal08.magtechjournal.com/Jwk_wjyx/CN/ 或 http://journal08.magtechjournal.com/Jwk_wjyx/CN/Y2018/V29/I3/253

[1]	陆再英,钟南山.内科学[M].7版.北京:人民卫生出版社,2008:362-366.
[2]	Barras M A,Kirkpatrick C M,Green B. Current dosing of low-molecular-weight heparins does not reflect licensed product labels:an international survey[J].Br J Clin Pharmacol,2010,69(5):520-528.
[3]	张菊霞,马玉霞,温玉洁,等.皮下注射低分子肝素时不同推注时间对皮下出血的影响[J].中华护理杂志,2014,49(2):233-235.
[4]	叶红.脐周鼓腹注射低分子肝素钙效果观察[J].护理学杂志,2014,29(1):49-50.
[5]	耿洪业.实用内科药物治疗学[M].北京:人民卫生出版社,2000,340:1119-1120.
[6]	于云,沈志奇,孙滕伟,等.急性冠状动脉综合症患者低分子肝素致皮下出血的危险因素[J].解放军医学院学报,2016,37(2):143-146.
[7]	朱敏,史作霞,张文彦,等.三联抗凝治疗患者低分子肝素脐周皮下注射部位的研究[J].护理学杂志,2011,26(23):39-40.
[8]	Alvisa Palese, Elena Aidone, Angelo Dante, Federico Pea. Occurrence and extent of bruising according to duration of administration of subcutaneous low-molecular-weight heparin [J]. J Cardiovasc Nurs,2013,28(5):473-482.
[9]	芦青华,高云秀,王晶,等.低分子肝素钙皮下注射时间及拔针时机对患者疼痛及皮下出血的影响[J].齐鲁护理杂志,2015,21(23):94-96.
[10]	Pourgbaznein T,Azimi A V,Jafatabadi M A.The effect of injection duration and injection site on pain and bruising of subcutaneous injection of hepain[J].Clin Nurs,2014,23(7/8):1105-1113.
[11]	Avsar G,Kasikci M.Assessment of four different methods in subcutaneous heparin application with regard to causing bruise and pain [J]. Int J Nurs Pract,2013,19(4):402-408.
[12]	Dehghani K, Najari Z, Dehghani H. Effect of subcutaneous Enoxaparininjection duration on bruising size in acute coronary syndrome patients[J].Iran J Nurs Midwifery Res,2014,19(6):564-568.
[13]	Campos J D,Silva J B,Beck A R,et al.Subcutaneous administration technique of low-molecular-weight heparins:an integrative review[J].Clin Nurs Stud,2013,1(4):36-44.
[14]	Palese A,Aidone E,Dante A,et al.Occurrence and exlent of bruising according to duration of administrstion of subcutaneous low-molecular-weight heparin:a quasi-experimental case-crossover study[J].J Cardiovasc Nurs,2013,28(5):473-482.
[15]	侯立君,马彩艳,陶娜娜.皮下注射低分子肝素钠不同按压时间的研究[J].护理实践与研究,2012,9(18):11-12.
[16]	金歌,屈清荣,王俊平,等.皮下注射低分子肝素优势方案研究[J].护理学杂志,2016,31(9):55-57.
[17]	龙艳,陈柳因.注射低分子肝素钙后按压与否对皮下出血的影响[J].护理实践与研究,2013,10(9):41-42.
[18]	郭晓岚,雷巧玲,金葵花,等.优化皮下注射低分子肝素流程在三联抗凝治疗患者中的应用[J].齐鲁护理杂志,2014,20(5):114-116.