低分子肝素皮下注射时间和按压时间对不良反应的影响研究

摘要

目的：探讨低分子肝素皮下注射时间和按压时间对不良反应的影响，找到最佳的注射方法，以减少皮下出血等不良反应的发生。方法选取2013年11—12月在河北医科大学第二医院心血管内科住院的首次行低分子肝素皮下注射的患者60例为研究对象，采用随机数字表法将患者均分为6组： A组（注射10 s，不按压）、 B组（注射10 s，按压5 min）、 C组（注射10 s，按压10 min）、 D组（注射30 s，不按压）、 E组（注射30 s，按压5 min）、 F组（注射30 s，按压10 min）。注射完即刻采用视觉模拟评分（ VAS）评价注射局部疼痛程度；注射后48 h用透明毫米软尺测量最大皮下出血直径。结果注射时间和按压时间对皮下出血直径无交互效应（ P＞0.05）。注射时间对皮下出血直径主效应显著（ P＜0.05）；按压时间对皮下出血直径主效应显著（ P＜0.05）。不同按压时间下注射30 s皮下出血直径均小于注射10 s （P＜0.05）。不同注射时间下按压5 min和按压10 min皮下出血直径均小于不按压（P＜0.05）；不同注射时间下按压5 min与按压10 min皮下出血直径比较，差异无统计学意义（P＞0.05）。注射时间和按压时间对注射局部疼痛程度无交互效应（P＞0.05）。注射时间对注射局部疼痛程度主效应显著（P＜0.05）；按压时间对注射局部疼痛程度主效应不显著（P＞0.05）。不同按压时间下注射30 s注射局部疼痛程度均低于注射10 s （P＜0.05）。不同注射时间下不按压、按压5 min、按压10 min注射局部疼痛程度比较，差异无统计学意义（P＞0.05）。结论为减少皮下出血和注射局部疼痛的发生，同时节省护理人员的时间，低分子肝素皮下注射时间应持续30 s，拔针后按压5 min。%Objective To investigate the injection duration and pressing duration on adverse effect caused by subcutaneous injection of low -molecular -weight heparin, in order to find the optimum method of injection and reduce the occurrence of adverse reactions like subcutaneous hemorrhage.Methods From November to December in 2013, we enrolled 60 inpatients who were going to receive the subcutaneous injection of low -molecular -weight heparin in the Department of Cardiology of the Second Hospital of Hebei Medical University.Using random number table method, the subjects were divided into 6 groups: group A ( injection for 10 s without pressing) , group B ( injection for 10 s and pressing for 5 min) , group C ( injection for 10 s and pressing for 10 min) , group D ( injection for 30 s without pressing) and group E ( injection for 30 s and pressing for 5 min) and group F ( injection for 30 s and pressing for 10 min) .Immediately after injection, visual analogue scale ( VAS) was employed to evaluate the intensity of local pain caused by injection; 48 hours after injection, the most maximum subcutaneous haemorrhage diameter was measured by transparent millimeter tape.Results Injection duration and pressing duration had no interaction effect on the diameter of subcutaneous hemorrhage ( P>0.05) .Injection duration had significant major effect on the diameter of subcutaneous hemorrhage ( P<0.05);pressing duration had significant major effect on the diameter of subcutaneous hemorrhage ( P<0.05) .Injection for 30 s caused smaller diameter of subcutaneous hemorrhage than injection for 10 s in the case of any pressing duration ( P <0.05 ) .Pressing for 5 min and pressing for 10 min caused smaller diameter of subcutaneous hemorrhage than no pressing in the case of any injection duration (P<0.05); pressing for 5 min and pressing for 10 min were not significantly different in the diameter of subcutaneous hemorrhage in the case of any injection duration (P>0.05) .Injection duration and pressing duration had no interaction effect on the intensity of local pain caused by injection ( P>0.05) .Injection duration had significant major effect on the intensity of local pain caused by injection ( P <0.05 ); pressing time had no significant major effect on the intensity of local pain caused by injection (P>0.05) .Injection for 30 s caused lower intensity of local pain caused by injection than injection for 10 s in the case of any pressing duration ( P<0.05) .There were no significant differences in the intensity of local pain caused by injection among no pressing, pressing for 5 min and pressing for 10 min in the case of any injection duration ( P>0.05) .Conclusion To reduce subcutaneous hemorrhage and local pain caused by injection and save time for nurses at the same time, the subcutaneous injection of low-molecular-weight heparin for 30 s and pressing for 5 min after the withdrawal of needles should be conducted.