冠状动脉介入治疗术后改良皮下注射低分了肝素方法的研究

目的 研究经皮冠状动脉介入治疗术(PCI)治疗术后皮下注射低分子肝素减轻局部并发症的方法.方法 随机选取135例住院行PCI后接受低分子肝素皮下注射的患者,采取在患者腹部两侧用2种方法注射的自身对照法,右侧使用常规注射法,左侧使用改良注射法,每例患者腹部两侧各皮下注射了4次,2种方法交替使用,各完成540针次,比较2种注射方法注射部位出血发生率、出血程度、注射疼痛感、皮下硬结发生率.结果 与常规注射组比较,改良注射组出血和疼痛发生率低,差异有统计学意义,P＜0.01;同时出血和疼痛程度轻,差异有统计学意义,P＜0.01;皮下硬结发生率明显低于常规注射组,差异有统计学意义,P＜0.01.结论 改良式注射法可以明显减少注射部位皮下出血程度、皮下硬结形成,减轻注射部位的疼痛程度及减少不良并发症,因此值得在临床上推广应用.     

冠状动脉介入治疗术后改良皮下注射低分子肝素方法的研究

目的研究经皮冠状动脉介入治疗术（PCI）治疗术后皮下注射低分子肝素减轻局部并发症的方法。方法随机选取135例住院行PCI后接受低分子肝素皮下注射的患者，采取在患者腹部两侧用2种方法注射的自身对照法，右侧使用常规注射法，左侧使用改良注射法，每例患者腹部两侧各皮下注射了4次，2种方法交替使用，各完成540针次，比较2种注射方法注射部位出血发生率、出血程度、注射疼痛感、皮下硬结发生率。结果与常规注射组比较，改良注射组出血和疼痛发生率低，差异有统计学意义，P〈0．01；同时出血和疼痛程度轻，差异有统计学意义，P〈0．01；皮下硬结发生率明显低于常规注射组，差异有统计学意义，P〈0．01。结论改良式注射法可以明显减少注射部位皮下出血程度、皮下硬结形成，减轻注射部位的疼痛程度及减少不良并发症，因此值得在临床上推广应用。     

腹壁注射低分子肝素钙不同进针法的临床观察

[目的]观察腹壁不同注射法注射低分子肝素钙法后局部出血情况.[方法]选取肺栓塞病人行低分子肝素钙皮下注射38例,采用自身对照的方法,每日首次注射采用常规皮下注射法,第2次采用改良注射法,各注射266例次,比较两组注射部位出血发生率及出血程度.[结果]与常规注射法比较,改良注射法出血发生率低、出血程度轻,差异有统计学意义(P＜0.01).[结论]采用改良注射法腹壁注射低分子肝素钙,可以明显减轻注射部位皮下出血程度、降低出血发生率.     

腹壁注射低分子肝素钙不同进针法的临床观察

[目的]观察腹壁不同注射法注射低分子肝素钙法后局部出血情况。[方法]选取肺栓塞病人行低分子肝素钙皮下注射38例,采用自身对照的方法,每日首次注射采用常规皮下注射法,第2次采用改良注射法,各注射266例次,比较两组注射部位出血发生率及出血程度。[结果]与常规注射法比较,改良注射法出血发生率低、出血程度轻,差异有统计学意义（P〈0．01）。[结论]采用改良注射法腹壁注射低分子肝素钙,可以明显减轻注射部位皮下出血程度、降低出血发生率。     

低分子肝素穿刺部位出血原因分析及注射方法探讨

目的 分析低分子肝素穿刺部位出血原因,探索防止出血的注射方法,保证低分子肝素钙的安全应用.方法 120例应用低分子肝素皮下注射的患者,均接受A、B两种注射法:A为改进注射法(气泡留置技术加平移腹壁皱褶30 s间期注射法),B为常规皮下注射法.A的注射部位为腹壁左侧,注射次数为618次,注射时间是30 s;B的注射部位为腹壁右侧,注射次数为617次,注射时间是10 s.通过自身对照,分析A、B两种方法注射后局部出血情况和疼痛程度.结果 A与B比较,穿刺部位出血发生率(由7 3.9%降低至37.2%)、平均出血直径(P＜0.01)及注射疼痛程度(P＜0.01)差异均有统计学意义.结论 A注射法可明显降低穿刺部位的出血发生率、减轻注射疼痛、提高低分子肝素使用安全性.     

不同方法皮下注射低分子肝素对老年患者发生不良反应的影响

目的探讨皮下注射低分子肝素时不同注射方法在减轻老年患者疼痛、皮下出血、硬结方面的效果。方法采取自身对照，分别进行常规注射和无痛注射，注射后由患者评定疼痛、皮下出血、硬结的程度。结果两种注射方法在减轻疼痛、皮下出血方面比较差异有统计学意义（P〈0．01）。结论用无痛注射方法可以有效降低皮下注射低分子肝素时疼痛、皮下出血、硬结的发生率。     

低分子肝素钠改良式皮下注射在深静脉血栓患者中的应用

目的观察低分子肝素钠改良式皮下注射方法对皮下出血发生率及出血面积的影响,找出有效的注射方法,以减少皮下出血的发生,缩小出血面积,减轻疼痛。方法选择普外科接受低分子肝素钠皮下注射治疗的47例患者,将其分为实验组和对照组,对照组23例患者采用传统皮下注射法进行注射,实验组24例患者采用改良皮下注射法进行注射,观察不同注射方法对皮下出血和疼痛的影响。结果改良注射法能明显降低注射部位及皮下出血的发生率,减小出血面积,减轻患者的疼痛(P0.01)。结论应用改良注射法注射低分子肝素钠可有效降低皮下出血的发生,减少皮下瘀斑的形成,减轻患者因皮下注射治疗所致的疼痛。     

改良低分子肝素钙注射方法对皮下出血的影响

目的：探讨改良低分子肝素钙皮下注射方法对皮下出血的影响。方法选择肺栓塞、不稳定性心绞痛和急性心肌梗死的患者100例,采用抽签分组法分为对照组和研究组各50例,两组各注射560例次,研究组采用改良注射法,对照组采用常规注射法。观察两组皮下出血、硬结面积及疼痛程度。结果研究组患者皮下出血、硬结面积＞2 cm有8例,对照组24例,两组比较差异有统计学意义（χ2＝32．71,P＜0．05）;研究组患者重度疼痛5例,对照组16例,两组比较差异有统计学意义（χ2＝10．98,P＜0．05）。结论改良注射方法减少了皮下出血和硬结例次,降低了疼痛程度,值得临床推广。     

改良低分子肝素注射方法对择期冠状动脉介入患者皮下出血的影响

目的探讨低分子肝素的注射部位、注射方法对择期冠状动脉介入患者皮下出血的影响。方法将250例行择期经皮冠状动脉介入术治疗的稳定型心绞痛患者,采用随机数字表法分为对照组和实验组,各125例。对照组采用传统注射法,实验组采用改良注射法,比较分析两组患者注射低分子肝素后致皮下出血的情况。结果实验组皮下出血发生率低于对照组,差异具有统计学意义(P0.01)。结论改良法皮下注射低分子肝素可有效减少择期冠状动脉介入患者皮下出血的发生率,有利于全面提高医疗护理质量。     

低分子肝素钙改良注射流程在心肌梗死患者治疗中的应用效果

目的:探讨改良低分子肝素钙注射流程在在心肌梗死患者治疗中的应用效果.方法:将256例心肌梗死患者随机分成观察组和对照组各128例.对照组按常规皮下注射方法操作,观察组按改良注射流程进行规范化操作,比较两组患者注射局部皮下出血、硬结发生情况及用药依从性.结果:观察组患者注射局部皮下出血、硬结发生情况及用药依从性均优于对照组(P＜0.05,P＜0.01).结论:改进低分子肝素钙注射流程可以减少皮下出血及硬结发生率,提高患者用药依从性,值得临床推广.     

宫颈癌术后使用依诺肝素抗凝延迟出现严重皮肤坏死一例

低分子肝素具有生物利用度高、半衰期长、不良反应少、使用方便等优点,被广泛应用于妇科肿瘤术后预防下肢静脉血栓形成。但在临床中发现有部分人群使用后出现皮下淤斑,大部分在停药后能自行消退。该文报道一例49岁女性患者,宫颈癌术后使用低分子肝素抗凝,致严重皮肤坏死,并继发窦道形成。该例患者诊断为宫颈中分化鳞癌IB3期,术后因并发下肢深静脉血栓形成,使用依诺肝素钠注射液抗凝共14 d,停药近1个月后出现右下腹淤斑肿块,考虑皮肤坏死,经换药处理7个月方愈。该例提示在使用依诺肝素过程中应注意其皮肤坏死不良反应。     

Subcutaneous tissue thickness in children with type 1 diabetes

AIM: This paper reports a study to measure the thickness of subcutaneous tissue at three major injection sites and to identify frequently used injection sites and injection methods. BACKGROUND: Glycaemic control is the key factor in the management of children with type 1 diabetes, and subcutaneous injection of insulin plays a major role in glycaemic control. However, only limited studies have examined the thickness of subcutaneous tissue at various injection sites. METHODS: The subcutaneous thickness in a convenience sample of 65 children aged 8-16 years attending a diabetes camp in 2002 was measured once per child at the outer arm, anterior thigh, and abdomen by one investigator using a Lange caliper. Injection sites and the method of injection were observed daily for four days by a trained investigator using a checklist. RESULTS: Median values of subcutaneous thicknesses at the outer arm, anterior thigh, and anterior abdomen for girls were respectively 18.00, 18.00 and 19.75 mm, and for boys were 17.00, 12.50 and 17.00 mm. In 40% of participants, the thickness of the subcutaneous tissue of the abdomen was <12.5 mm. Boys over 14 years old had statistically significantly thinner subcutaneous tissue at all injection sites than that of age-matched girls. The anterior abdomen was the most common injection site in boys, and the anterior thigh in girls. Perpendicular injection without skin-folding was the most frequently used injection method. Body Mass Index was statistically significantly correlated with subcutaneous tissue thickness at all sites. CONCLUSION: A needle shorter than a 12.5-mm needle should be used, particularly for boys. Injection with skin-folding may decrease the possibility of intramuscular injection.     

Comparison of different dose regimens of enoxaparin in deep vein thrombosis therapy in pregnancy

INTRODUCTION: Pregnant women have a higher risk of developing deep vein thrombosis (DVT) and consequent thrombogenic events, including pulmonary embolisms. Low-molecular-weight heparin (LMWH) products have been shown to successfully treat DVT with few significant side effects. The purpose of this study was to compare the effects of two dose regimens of enoxaparin (a LMWH) in the management of DVT in pregnancy. METHODS: A total of 35 pregnant patients with DVT were enrolled in this study. As first-line anticoagulation therapy, patients were administered an intravenous unfractionated heparin infusion for 5 days, followed by a subcutaneous injection of enoxaparin 1 mg/kg twice a day until discharge. The enoxaparin therapy continued at home with 1 mg/kg twice a day for 18 patients (group I) and 1.5 mg/kg once a day for the other 17 patients (group II). Enoxaparin was discontinued 12-24 hours before delivery and restarted within 8-12 hours after delivery. Warfarin was given as adjuvant therapy along with enoxaparin in the post-partum period. Enoxaparin was discontinued when an international normalised ratio of 2 or above was reached. Differences between the two groups in terms of therapy response, complications and efficacy were recorded. RESULTS: Thrombophilic disease was observed in three patients in each group. The iliac vein had the highest incidence of DVT in both groups. During therapy, two patients in group I were diagnosed with a mild haemorrhage; one patient (in group II) had abortion. There were no significant differences between groups in terms of recanalisation (measured by venous ultrasonography examination), post-thrombotic symptoms or safety parameters. CONCLUSION: Enoxaparin can be used safely in DVT therapy during pregnancy. Our results indicate that therapy consisting of a single daily dose of 1.5 mg/kg enoxaparin is as effective as twice-daily administration.     

A simple test for the monitoring of plasma anti-XA activity of patients following subcutaneous administration of enoxaparin

Since low molecular weight heparin is used for the prevention of thromboembolism, the coagulation laboratories are in need of a simple, reliable and practicable test for factor Xa inhibition in order to monitor the effect of low molecular heparin in plasma. Effects of subcutaneous administration of 20 mg or 40 mg enoxaparin were studied in blood samples drawn from 20 patients before and 1, 2, 3, 4, 6, 12 and 24 hours after injection. Thrombin time, aPTT, Heptest and the anti-Xa activity (amidolytic assay) were measured. Subcutaneous administration of 20 mg or 40 mg enoxaparin was followed by a barely significant (p less than 0.05) rise in aPTT (only at the higher dosage) and thrombin time four hours after injection. Heptest and amidolytic assay (S-2222) correlated well and significant (p less than 0.01) increases, with maximum values 4 hours after injection, were seen after administration of 20 mg as well as of 40 mg enoxaparin. Higher mean values were achieved after injection of 40 mg than 20 mg enoxaparin. We believe the Heptest to be a quick and easily performed test, giving results which agree well with those of the amidolytic anti-Xa activity reference method.     

不同注射部位对干扰素治疗慢性丙型肝炎的效果比较

目的:探讨腹部皮下注射法与传统的三角肌皮下注射法在干扰素治疗慢性丙型肝炎的疗效及副作用。方法:将64例符合《病毒性肝炎防治方案》中拟定的标准的丙型肝炎病毒慢性感染患者随机分为实验组36例和对照组28例,均给予皮下注射聚乙二醇干扰素α-2a 135μg/次,1次/周,同时口服利巴韦林1 000 mg/d,共治疗48周。实验组采用腹部皮下注射法,对照组给予三角肌皮下注射法。结果:实验组注射部位疼痛程度、皮肤局部红肿、硬结情况优于对照组(P<0.01,P<0.05)。结论:腹部皮下注射法既能达到治疗目的,又可减少疼痛程度、皮下硬结的发生,值得临床推广。     

低分子肝素皮下注射持续时间对注射部位皮下出血的影响

目的比较皮下注射低分子肝素持续注射时间对注射部位皮下出血的影响。方法选择使用低分子肝素的老年冠心病患者30例,采用自身对照,每例患者在腹部两侧注射,左侧注射持续10s,右侧注射持续30s。24h后观察皮下出血例次及出血面积的大小。结果注射持续30s比注射持续10s能明显降低注射部位皮下出血率及出血面积。结论延长低分子肝素注射时间可有效降低注射部位皮下出血发生率及出血面积。     

Impact of stage 3B chronic kidney disease on thrombosis and bleeding outcomes after orthopedic surgery in patients treated with desirudin or enoxaparin: insights from a randomized trial

Summary. Background: Venous thromboembolism (VTE) remains a significant complication of major orthopedic surgery, and chronic kidney disease (CKD) is common among elderly patients undergoing total hip replacement (THR). Objectives: The purpose of this study was to evaluate thrombosis and bleeding outcomes in patients with stage 3B CKD treated with either desirudin or enoxaparin after elective THR. Patients/Methods: This was a post hoc subgroup analysis of a randomized, multicenter, double‐blind study of desirudin vs. enoxaparin in patients undergoing elective THR. Results: Patients received either subcutaneous desirudin 15 mg twice daily or subcutaneous enoxaparin 40 mg once daily. Of the 2078 randomized patients who received study medication, 577 had stage 3B CKD or worse (27.8%), and the proportion of these patients who experienced a major VTE in the enoxaparin treatment group was found to be much higher than in the desirudin treatment group (11.1% vs. 3.4%, model‐adjusted odds ratio 3.52, 95% confidence interval 1.48–8.40, P = 0.004). There was no statistically significant difference between treatment groups in terms of rates of major bleeding, regardless of stage of renal function. Conclusions: CKD has been reported previously to increase the risk of bleeding with anticoagulants, and these findings suggest that CKD may also increase the risk of major VTE for patients treated with enoxaparin, but not for patients treated with desirudin. Clinicians should consider the impact of CKD on the risk of VTE when choosing a prophylaxis agent.     

Effects of accidental intramuscular injection on insulin absorption in IDDM

Recent studies have shown that with the injection technique presently recommended to diabetic patients, accidental intramuscular injection of insulin is liable to occur quite frequently. In this study, the simultaneous absorption of 125I-labeled soluble human insulin (5 U) from subcutaneous and intramuscular injection sites in the thigh and abdomen was measured for 3 h in 10 insulin-dependent diabetic subjects to evaluate the importance of accidental intramuscular injection for insulin absorption in the resting state. Injection sites were located with computed tomography of the thigh and abdomen. From a superficial part of the thigh musculature, the absorption rate was at least 50% higher than from the adjacent subcutaneous tissue, the time until 50% of the initial activity remained (t1/2) being 123 +/- 14 and greater than 180 min, respectively (P less than .001). No difference in absorption rates was found between the two tissues in the abdomen (t1/2 84 +/- 6 vs. 93 +/- 7 min, NS). The results suggest that in the thigh, accidental intramuscular injections will considerably increase the variability of insulin absorption and may impair glycemic control in insulin-dependent diabetic patients. Furthermore, the influence of accidental intramuscular injection on insulin absorption seems to vary among injection regions.