妊娠晚期深静脉血栓形成抗凝治疗中改良腹壁皮下注射部位的临床应用

Clinical application of modified abdominal subcutaneous injection site in anticoagulant therapy for deep venous thrombosis in late pregnancy female patients

目的探讨改良腹壁皮下注射部位(以下称改良部位)及分区方法在妊娠晚期下肢深静脉血栓形成抗凝治疗中的安全性、可行性、有效性。方法纳入2015年1月至2017年12月20例低分子肝素抗凝治疗的妊娠晚期深静脉血栓形成(DVT)患者的临床资料,以低分子肝素不同注射部位分为2组,每组10例分析注射部位皮下组织厚度、皮下出血发生率、血浆anti-Xa因子活性水平、疼痛评分,探讨改良部位的可行性、有效性。结果皮下组织厚度:脐周10cm内为(8.4±1.9)mm,小于低分子肝素(速碧林)注射针头长度;三角肌下缘、前腹壁、侧腹壁分别为(17.7±4.2);(20.2±4.6);(26.8±5.6)mm,均大于针头长度,且差异有统计学意义(F=247.355,P<0.001);前腹壁及侧腹壁组内差异无统计学意义(F=2.156,1.858;P=0.100,0.144)。实验组和对照组血浆arti-Xa活性水平均于治疗第5天达到治疗浓度,差异无统计学意义(P>0.05)。注射部位瘀点、紫癜及皮下出血的总发生率差异有统计学意义(F=17.807,4.824,22.260;P<0.001,P=0.028,P<0.001)。穿刺及拔针即刻疼痛评分差异存在统计学意义(t=7.182,5.813;P<0.001,P=0.047)。结论与上臂部、脐周10cm内(传统注射部位)相比,改良部位及分区法具有安全性高、治疗效果可靠、并发症少、舒适度高、便于自我注射的优势,是妊娠晚期皮下注射部位选择的优先方案。

Objective To investigate the safety,feasibility and effectiveness of modified abdominal subcutaneous injection site(hereinafter referred to as modified site) and zoning method in anticoagulant therapy for deep venous thrombosis(DVT) in late pregnancy(third trimester of pregnancy) female patients.Methods The clinical data of 20 female patients with DVT in late pregnancy,who received low molecular weight heparin (LMWH) anticoagulant therapy during the period from January 2015 to December 2017,were collected. According to the injection site of LMWH,the patients were randomly and equally divided into study group (n=10) and control group(n=10).The subcutaneous tissue thickness at different injection sites,the incidence of subcutaneous hemorrhage at the injection site,the plasma anti- Xa factor activity level and the pain score were calculated,the results were compared between the two groups,and the feasibility and effectiveness of using modified site as the injection site were discussed.Results The thickness of subcutaneous tissue within 10 cm around umbilicus was (8.4±1.9) mm,which was less than the length of LMWH needle(fraxiparine).The thickness of subcutaneous tissue at the lower border of deltoid muscle,anterior abdominal wall and lateral abdominal wall were (17.7±4.2) mm,(20.2±4.6) mm and (26.8±5.6) mm respectively,which was larger than the length of LMWH needle,and the differences were statistically significant(F=247.355,P=0.100).In the anterior abdominal wall group and lateral abdominal wall group the differences were not statistically significant (F=2.156,P=0.100 and F=1.858,P=0.144 respectively).In both the study group and the control group,the plasma anti- Xa activity levels reached the therapeutic level on the 5th day of treatment,the difference was not statistically significant (P >0.05).The differences in the total incidence of petechiae,purpura and subcutaneous hemorrhage at the injection site between the two groups were statistically significantly(F=17.807, F=4.824,F=22.260 and P<0.001,P=0.028,P<0.001 respectively).Statistically significant differences in immediate pain scores at puncturing of needle and at withdrawal of needle existed between the two groups(t= 7.182,t=5.813 and P<0.001,P=0.047 respectively).Conclusion Compared with the traditional injection site(upper arm and abdominal wall within 10 cm around umbilicus),the injection at the modified site with zoning method has the advantages of high safety,reliable therapeutic effect,less complications,high comfort and easy self - injection.The modified site injection is a priority scheme for subcutaneous injection in late pregnancy female patients with DVT who are receiving LMWH anticoagulant therapy.