急性冠状动脉综合征患者低分子肝素致皮下出血的危险因素

Risk factors of subcutaneous hemorrhage caused by low molecular weight heparin in patients with acute coronary syndrome

目的探讨急性冠状动脉综合征(acute coronary syndrome,ACS)患者临床应用低分子肝素致皮下出血的危险因素。方法选取2014年10月-2015年6月入住武警总医院心脏病监护病房(CCU)的ACS患者80例,采用自身对照的前瞻性研究,每例患者接受两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,拔针后轻按注射点10 s;方法 B:注射10 s,停留10 s之后拔针,拔针后按压注射点5 min。根据患者皮下注射48 h后有无皮下出血,将注射分为出血组和对照组,对两组的年龄、性别、糖尿病史、胰岛素应用、体质量指数、腹部皮褶厚度、血小板、INR指数、部分凝血活酶时间(activated partial thromboplastin time,APTT)等资料进行单因素和多因素Logistic回归分析,得出皮下出血的危险因素。结果每例接受2次注射,160次注射中出血组94次(出血组)、未出血组66次(对照组),两组年龄、性别、糖尿病史、是否应用胰岛素、血小板计数、INR指数、APTT差异无统计学意义(P>0.05);两组注射后按压注射点程度、体质量指数、腹部皮褶厚度差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,注射后按压注射点程度是皮下出血的独立危险因素(P<0.05)。结论低体质量指数ACS患者临床应用低分子肝素更易出现皮下出血,而拔针后的按压程度(大力度,长时间)则是其独立危险因素。

Objective To investigate the risk factors of subcutaneous hemorrhage caused by low molecular weight heparin in acute coronary syndrome patients and provide references for effective precaution. Methods Eighty adult patients who admitted to coronary care unit in General Hospital of Chinese People＇s Armed Police Forces from October 2014 to June 2015 were enrolled in this study. They were administered heparin subcutaneously, each patient received two injections in two ways. Way A： patients were injected for 10 s, and needles were pulled out after 10 s, the injection areas were pressed gently for 10 s; Way B： patients were injected for 10 s, and needles were pulled out after 10 s, the injection areas were pressed gently for 5 min. Injection areas were assessed for the presence of subcutaneous hemorrhage at 48 h after each injection and patients were divided into hemorrhage group and control group. Clinical data about patients were retrospectively analyzed, including age, gender, BMI, abdominal skinfold, diabetes history, using insulin, APTT, INR and platelet number. Univariate and multivariate Logistic regression analysis were conducted to compare the indicators mentioned above between the two groups to find out the risk factors. Results Hemorrhage group had 94 injections, and control group had 66 injections. Age, gender, diabetes history, using insulin, APTT, INR and platelet number were not significantly different between the two groups（P〉0.05）; BMI, abdominal skinfold and pressing were significantly different between the two groups（P〈0.05）. The multivariate Logistic regression analysis showed that pressing after injection was a risk factor（P〈0.05）. Conclusion Patients with low BMI seem to be prone to have subcutaneous hemorrhage, but the degree of pressing（heavy strength, long time） is a risk factor of subcutaneous hemorrhage.