改良低分子肝素注射方法减少皮下出血的研究进展

介绍改进低分子肝素注射方法减少皮下出血的研究进展,从注射的部位、深度、角度以及压迫时间、力度和注射点间距等方面进行了阐述.提出选择脐周腹壁进行注射、捏起皮肤、垂直近针、注射前不排气、拔针后有效压迫3 min是比较理想的方法.     

改良低分子肝素注射方法减少皮下出血的研究进展

介绍改进低分子肝素注射方法减少皮下出血的研究进展，从注射的部位、深度、角度以及压迫时间、力度和注射点间距等方面进行了阐述。提出选择脐周腹壁进行注射、捏起皮肤、垂直进针、注射前不排气、拔针后有效压迫3min是比较理想的方法。     

低分子肝素皮下注射方法与皮下出血的探讨

目的:探讨冠心痛支架植入术后患者皮下注射低分子肝素,减少皮下发生出血的注射方法.方法:随机选取2011年4月-10月冠心病支架植入术后住院患者66人,分析采用不同的皮下注射方法与皮下出血的关系,从而了解不同注射方法对皮下出血的影响.结果:实验组皮下出血的发生率明显小于对照组,且实验组皮下出血面积明显轻于对照组.结论:采用改进的皮下注射方法,可减少皮下出血的发生.     

开展品管圈活动降低低分子肝素钙腹壁皮下出血的效果研究

目的通过开展品管圈活动来降低心内科住院患者低分子肝素钙腹壁皮下注射所致皮下出血的发生率,提高护理质量和护士参与护理质量管理的主观能动性。方法成立品管圈小组,确立"降低低分子肝素钙所致腹壁皮下出血的发生率"为活动主题,运用品管圈活动的10大步骤,调查现状对皮下出血发生的原因进行分析梳理找到4个真因,针对真因制定3项对策:制定规范化操作流程,并作为科室护理重点环节监测指标并实施;加强培训考核,统一宣教内容;根据按压方法分两组进行皮下注射并登记,拔针后统一由护士按压。结果开展品管圈后,住院患者注射低分子肝素钙后腹壁皮下出血的发生率从改善前的38.53%下降至改善后按压组17.20%及改善后不按压组的21.23%,差异具有统计学意义(均P0.0125),且不同面积皮下出血改善前后比较差异有统计学意义(P0.01)。圈员8项能力自我评价均显著提高。结论应用品管圈活动能有效降低住院患者注射低分子肝素钙后腹壁皮下出血的发生率,且能提高护士的实际操作能力及主动解决临床问题的能力。     

低分子肝素钙腹壁皮下注射后按压方式对老年患者皮下出血的影响

目的探讨老年患者低分子肝素钙腹壁皮下注射后按压方法与皮下出血率及皮下出血面积的关系,寻找最佳按压方法,从而降低皮下出血率及出血面积。方法选择2016-10—2017-01间在郑大二附院老年医学科一病区需预防性使用低分子肝素钙的患者42例,采用自身对照方法,将每例患者的10次皮下注射分成2组。前5次皮下注射为对照组,采用常规按压方法;后5次皮下注射为观察组,采用改良后的按压方法。结果 42例患者共接受腹壁皮下注射420次,对照组和观察组各210次。观察组皮下出血率及出血面积均明显低于对照组,差异有统计学意义(P0.05)。结论改良后的按压方法可以有效降低老年患者腹壁皮下注射低分子肝素钙的出血率及出血面积。     

垂直法注射低分子肝素减少患者不良反应的观察

目的探讨减少低分子肝素不良反应的注射方法。方法将80例皮下注射低分子肝素患者随机分为观察组和对照组各40例,对照组采用传统方法注射,观察组采用垂直方法注射。结果观察组不良反应发生率明显低于对照组,两组比较,差异有显著性意义(P<0.01)。结论垂直法注射低分子肝素能够有效降低不良反应的发生率,对减轻患者紧张心理及病痛有积极的作用。     

低分子量肝素引起手术区大出血二例

例 1男 ,30岁 ,因外伤后左小腿软组织缺损及足畸形入院 ,进行左背阔肌部位予构扩张游离皮瓣吻合血管移植术 ,修复小腿矫形后的创面[1] 。游离皮瓣 40ｃｍ× 16ｃｍ ,供瓣的胸背静脉和受区的腓肠肌外侧头营养静脉端端吻合 ,供瓣的胸背动脉和受区左小腿腘动脉端侧吻合。因受区瘢痕较重 ,静脉回流不畅 ,皮瓣轻度充血。为预防吻合口血栓形成 ,于术后4ｈ按照药品说明 ,腹部皮下注射低分子量肝素 40ｍｇ(1ｍｇ=10 0ＩＵ ,依诺肝素ｃｌｅｘａｎｅ ,Ｂｅｌｌｏ公司 )。 40ｍｉｎ后患者皮瓣突隆边缘渗血 ,拆去部分缝线见皮瓣组织面及基底创面广泛出血…     

脐周鼓腹注射低分子肝素钙效果观察

目的探讨脐周鼓腹注射低分子肝素钙的效果。方法选择98例应用低分子肝素钙治疗患者,按随机数字表法分为两组各49例。观察组采用脐周鼓腹垂直注射法,对照组提捏腹部皮肤形成皱褶垂直注射。结果观察组皮下出血及疼痛程度显著轻于对照组(均P0.01).结论脐周鼓腹垂直注射低分子肝素钙,可减轻皮下出血及疼痛。     

低分子肝素皮下注射局部压迫与否对出血的影响

目的 探讨低分子肝素(LMWH)皮下注射后局部压迫与否与局部出血的关系。方法 选择60例冠心病行皮下注射LMWH的病人,采用自身对照法,即一次注射后局部不压迫,另一次注射后局部压迫3～5 min。观察皮下出血发生率及出血程度。结果 局部不压迫皮下出血率及重度出血率显著低于压迫者(均P<0.01)。结论 皮下注射LMWH局部不压迫可以有效降低皮下出血发生率及其严重程度。     

持续皮下注射胰岛素治疗糖尿病高血糖危象效果观察

目的 探讨持续皮下注射胰岛素治疗糖尿病高血糖危象的疗效和护理方法.方法 将53例因高血糖危象急诊住院治疗的糖尿病患者分为两组.泵组(20例)使用胰岛素泵持续皮下注射胰岛素;小剂量组(33例)静脉滴注小剂量胰岛素,血糖控制后改为胰岛素餐前皮下注射.连续10 d后评价效果.结果 两组均可迅速降低高血糖(均P＞0.05);泵组降糖更稳定(均P＜0.01),但低血糖发生率显著高于小剂量组(P＜0.05).结论 持续皮下注射胰岛素能迅速降低血糖,可使血糖维持在较稳定水平;充分补液和严密监测血糖变化可望降低低血糖发生率,提高治疗安全性.     

疏血通联合低分子肝素钠治疗深静脉血栓的疗效观察

目的探讨疏血通联合低分子肝素钠治疗下肢深静脉血栓症的临床疗效和安全性。方法将70例下肢深静脉血栓症患者随机分为试验组和对照组,每组各35例。对照组予低分子肝素纳5000U皮下注射,每12小时1次。试验组在此基础上加用疏血通注射液6mL＋生理盐水250mL静脉点滴,每天1次,10d为一疗程。结果试验组总有效率94.3%,对照组为68.6%,两组比较差异有统计学意义（P〈0.05）,两组均未出现严重不良反应。结论疏血通联合低分子肝素钠治疗下肢静脉血栓症疗效显著,安全性好。     

三联抗凝治疗患者低分子肝素脐周皮下注射部位的研究

目的探讨三联抗凝治疗患者低分子肝素脐周注射的最佳部位,降低皮下出血发生率。方法将389例脐周皮下注射低分子肝素同时口服拜阿司匹林、硫酸氢氯吡格雷片患者采用自身对照法,分别于脐至外侧缘连线,将左侧连线分为3等份,选择外1/3处上下5cm范围进行注射;将右侧连线分为2等份,选择1/2处上下5cm范围进行注射。两处各注射2 080例次,观察皮下出血的发生率。结果 1/3处皮下出血发生率显著低于1/2处(P<0.01)。结论三联抗凝治疗患者行低分子肝素脐周皮下注射时选择在腹部外侧部位进针,可减少皮下出血。     

Acute Effect of Standard Heparin Versus Low Molecular Weight Heparin on Oxidative Stress and Inflammation in Hemodialysis Patients

Objective. Atherosclerotic cardiovascular diseases caused by traditional and non-traditional risk factors are the most common cause of morbidity and mortality in hemodialysis patients. Recently, much interest has been focused on non-traditional factors, such as oxidative stress, inflammation, and endothelial dysfunction. Hemodialysis patients are not only exposed to oxidative stress but also to inflammation. Although anticoagulants are the most frequently used drugs in hemodialysis patients, their effect upon oxidative stress and inflammation in dialysis patients are still unknown. Methods. Thirty-three hemodialysis patients were randomized into three groups. Group 1 received standard heparin while group 2 received low molecular weight heparin during the dialysis therapy. Group 3 (control group) did not receive any anticoagulant agent. Investigators were blinded to the therapy. Serum concentrations of oxidative stress and inflammation markers, including C-reactive protein, tumor necrosis factor alpha, superoxide dismutase, and malondialdehyde, were measured before and after dialysis session. Results. The oxidative stress and inflammation markers were significantly increased in groups 1 and 3 (p < 0.05 for each) compared to their baseline values. In contrast, baseline and end-treatment values of the oxidative stress and inflammation markers were comparable in the group 2 (p > 0.05). Conclusion. These findings indicate that the type of anticoagulants may take a role in the acute effect of hemodialysis upon oxidative stress and inflammation markers. A comparison of the groups revealed that low molecular weight heparin decreased the oxidative stress and inflammation, whereas standard heparin increased the oxidative stress and inflammation. Low molecular weight heparin appears to have an additive benefit for hemodialysis patients.     

Effects of Low Molecular Weight Heparin on the Frequencies of Intradialytic Arrhythmias in Hemodialysis Patients

Arrhythmia is known to cause sudden death in hemodialysis patients. Heparin administration releases lipoprotein lipase from the capillary endothelial cell surface, resulting in an increase in the plasma levels of free fatty acids; higher levels of free fatty acids may affect the occurrence of arrhythmias. This study assessed whether the occurrence of arrhythmias during hemodialysis could be suppressed by replacing unfractionated heparin with low molecular weight heparin. Ten dialysis patients who had supraventricular premature contraction and/or ventricular premature contraction were monitored by the Holter electrocardiograph system during hemodialysis. To investigate the effect of each form of heparin on plasma lipid metabolism, the lipoprotein lipase and lipid levels before and during hemodialysis were measured. The occurrence of arrhythmias was significantly suppressed in hemodialysis using low molecular weight heparin, as compared with hemodialysis using unfractionated heparin. Lower lipoprotein lipase and free fatty acids levels were also observed in hemodialysis using low molecular weight heparin. The authors concluded that hemodialysis using low molecular weight heparin instead of unfractionated heparin could be effective in protecting hemodialysis patients with arrhythmias against arrhythmia-related cardiac events.     

红花黄色素联合低分子肝素预防骨科术后深静脉血栓Meta分析

目的:评价红花黄色素联合低分子肝素预防骨科术后深静脉血栓形成(DVT)的疗效及安全性。方法:全面检索PubMed、EMbase、Cochrane Library、CNKI、维普和万方数据库中收录的红花黄色素联合低分子肝素预防骨科术后DVT的随机对照研究(RCT),检索时限从2000年1月—2018年6月。提取资料进行质量评价,采用Rev Man5.3软件进行Meta分析。结果:共纳入8个RCT,包括624例患者。与对照组相比,联合组显著降低了DVT发生率[RR=0.28,95%CI(0.16,0.51),P0.0001];联合组活化部分凝血活酶时间(APTT)[MD=5.34,95%CI(2.31,8.36), P=0.0005]、凝血酶原时间(PT)[MD=3.09,95%CI(1.75,4.44), P0.00001]显著优于对照组。两组不良反应发生率无明显差异。结论:红花黄色素联合低分子肝素预防骨科术后DVT疗效优于单用低分子肝素。     

低分子肝素钠股动脉注射治疗糖尿病下肢血管病变疗效观察

目的观察低分子肝素钠股动脉注射治疗糖尿病下肢血管病变的疗效。方法对40例糖尿病下肢血管病变患者在治疗糖尿病的基础上给予低分子肝素钠股动脉注射。观察治疗后临床症状、血液流变学以及血流动力学改善情况。结果治疗后患者临床症状、血液流变学以及血流动力学改善明显,治疗前后比较,差异有显著性意义(P<0.05,P<0.01);未发现不良反应。结论低分子肝素钠股动脉注射对糖尿病下肢血管病变疗效显著,安全。