改良低分子肝素注射方法对局部皮下出血的影响

Effect of Different Injection Methods of Low Molecular Weight Heparin on the Subcutaneous Hemorrhage

目的观察心房颤动(房颤)患者围手术期应用低分子肝素(LMWH)中,改良的皮下注射方法对LMWH所致皮下出血的影响。方法选取导管射频消融术治疗的房颤患者62例,均为术前、术后需连用LMWH 5～6 d。每例患者腹部皮下注射LMWH 2次/d,1次/12 h,累计680例次。将9:00注射左侧腹部为对照组(340例次),21:00注射右侧腹部为屏气组(340例次)。同时,为观察屏气时局部压迫时间的作用,每组进一步划分为长时压迫组与短时压迫组,各170例次。结果屏气组的淤斑发生率4.1%显著低于对照组11.5%(P<0.001);短时压迫情况下,屏气组淤斑发生率显著低于对照组(2.4%和7.6%,P<0.05)。结论在房颤患者导管消融治疗围手术期的LMWH注射过程中,嘱患者屏住呼吸可以明显降低皮下淤斑的发生率。

Objective To investigate the impact of breath control during the injection of low molecular weight heparin （LMWH） on the subcutaneous hemorrhage in patients who underwent catheter ablation for atrial fibrillation. Methods 62 patients undergoing catheter ablation for atrial fibrillation were administrated with warfarin orally for more than three weeks. LMWH was then subcutaneously injected, every 12 hours, in the abdominal area from three days before ablation to three days after ablation. Totally, 680 times of injections were achieved. The patients were grouped into left abdominal injection spot group （control group, n=340） and right injection spot group （breath holding group, n=340）. Each group was equally divided into two subgroups （one with short-time pressing and the other with long-time local pressing）. Results The incidence of subcutaneous hemorrhage or bruising was significantly lower in breath holding group than that in control group （4.1% vs. 11.5%, P〈0.001）. In case of short-time pressing, the incidence in the breath holding group was lower than that in the control group （2.4% vs. 7.6%, P〈0.05）. Conclusion Breath holding during subcutaneous LMWH injection for the patients with catheter ablation for atrial fibrillation may reduce the incidence of subcutaneous hemorrhage.