关节置换术后低分子肝素钙注射方法的操作探讨

目的探讨关节置换术后患者不同的低分子肝素钙注射方法对皮下出血和疼痛程度的影响。方法选取2010年1月至2012年12月行单侧膝关节置换术手术患者100侧，采用随机自身对照的方法，观察不同注射部位、进针角度及注射后不同按压时间所产生的皮下出血、疼痛等不良反应。结果采用腹部注射法的患者皮下出血发生率为34．9％，低于上臂三角肌注射患者的40．4％，腹部注射患者视觉模拟评分（VAS）为0分的患者占34．3％，高于上臂三角肌注射患者的27．8％，不同注射部位皮下出血程度不同（Z=-2．552，P〈0．05），疼痛评分不同（Z=-5．504，P〈0．01）。采用垂直进针法的患者皮下出血发生率为34．3％，低于斜度进针注射患者的41．4％，垂直进针法VAS法评分为。分的患者占23．2％，高于斜度进针注射患者的20．9％，不同进针角度皮下出血程度不同（Z=-0．035，P〈0．01），疼痛评分不同（Z=-2．483，P〈0．05）。注射后按压1、3、5min患者皮下出血发生率分别为47．9％、45．4％和33．7％，出血程度差异有统计学意义（Z=27．524，P〈0．01）。结论腹部注射、垂直进针方法注射低分子肝素钙具有较低的皮下出血率，患者疼痛程度轻，值得临床推广，注射后适度增加按压时间能有效减少皮下出血率。

Exploration of the low molecular weight heparin calcium calcium injection for patient with arthroplasty

Objective To investigate the subcutaneous bleeding and pain extent in different injection method of low low molecular weight heparin calcium for patients with arthroplasty. Methods Selected 100 patients undergoing unilateral total knee arthroplasty（TKA） surgery in January 2010 to December 2012 as objects, used a random method of self control,observed the degree of subcutaneous bleeding and level of pain under the different injection sites,nee- dle angle and push different times. Results The incidence of subcutaneous bleeding in patient using abdominal subcu taneous injection was 34.9 %, lower than the upper arm deltoid injection patients（40.4 ~ ）, VAS pain score of 0 in pa- tients with abdominal injection accounted for 34.3% ,higher than the upper arm deltoid injection patients（27.8%）, the degree of subcutaneous bleeding under the different injection site was different （Z =- 2. 552, P〈~ 0. 05）, pain scores was different too（Z=- 5. 504, P~0.01 ）;the subcutaneous hemorrhage incidence of patients using vertical puncture was 34.3 %0 ,lower than the slope puncture injection patients（41.4 %） ;VAS score of 0 in patients with ver tieal puncture accounted for 23.2 %, higher than the patients with slope puncture（20.9 ~ ）, subcutaneous hemorrhage in patient with different puncture angle was different （Z = --3. 035, P ~ 0. 01）, pain scores were different （Z= --2. 483 ,P＊~0.05） ;the subcutaneous hemorrhage rates in patient with injection press lmin,3min,5min respec tively were 47.9 %, 45.40/40 and 33.7 %, statistically significant differences in the degree of bleeding（Z= 27. 524, P〈 0.01）. Conclusion Abdomen injection,vertical needle injection method of low molecular weight heparin calcium has a low incidence of subcutaneous bleeding and controllable pain, it is worthy of promotion, modest increase press time af- ter injection can effectively reduce subcutaneous bleeding.