目的 探讨急性冠状动脉综合征(acute coronary syndrome,ACS)患者低分子肝素(low molecular weight heparin, LMWH)皮下注射和按压时间对皮下出血和疼痛的影响。方法 选择医院200例ACS患者,采用自身对照的类实验性研究方法,每例患者接受四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,不按压;方法B:注射10 s,停留10 s之后拔针,拔针后按压5 min;方法C:注射30 s后拔针,不按压;方法D:注射30 s后拔针,拔针后按压5 min。注射完毕即刻采用视觉模拟评分(visual analogue scale ,VAS)评价注射局部疼痛程度,注射后48 h测量最大皮下出血直径。结果 方法A的注射部位皮下出血发生率(40.5%)最低,与其他方法(67.0%、58.5%、58.0%)比较,差异有统计学意义(P＜0.001);四种方法的皮肤变色直径依次为(2.58±2.23)mm、(7.87±11.26)mm、(3.81±3.69)mm和(6.15±9.97)mm,A、C方法皮肤变色直径明显低于B、D方法,差异有统计学意义(P＜0.05),A与C方法之间无统计学差异。方法A的注射部位疼痛发生率(44.5%)最低,与方法B(59.5%)比较,差异有统计学意义(P＜0.05);四种方法的疼痛评分依次为(0.70±0.93)、(1.13±1.29)、(0.94±1.27)和(1.18±1.46),A方法疼痛评分明显低于B、D方法,差异有统计学意义(P＜0.05),A与C方法之间无统计学差异。结论 ACS患者进行LMWH皮下注射治疗时,采用注射10 s,停留10 s,拔针后不按压的方法,能明显降低患者注射部位皮下出血及疼痛的发生率,同时减少护士的工作量。

Objective To investigate the effect of the injection duration and pressing time of subcutaneous low molecular weight heparin on bruising and pain in patients with acute coronary syndrome (ACS) during antiplatelet therapy, and to find an effective surgical method.Methods Two hundred patients with ACS were enrolled in this study. They were administered with heparin subcutaneously, and each patient received four injections in four different ways. Way A: patients were injected for 10 s, needles were pulled out after 10 s ,and the injection areas were not pressed. Way B: patients were injected for 10 s, needles were pulled out after 10 s, and the injection areas were pressed for 5 min. Way C: patients were injected for 30 s, needles were pulled out ,and the injection areas were not pressed. Way D: patients were injected for 30 s, needles were pulled out ,and the injection areas were pressed for 5 min. The degree of pain at the injection site was evaluated with visual analogue scale (VAS) when the injection was finished, and the largest discoloration diameter was measured 48 h after injection.Results Way A’s incidence of subcutaneous bleeding(40.5%) was the lowest. Compared with other ways (67.0%, 58.5%, 58.0%), the difference was statistically significant(P<0.001).The skin discoloration diameters of the four ways were(2.58±2.23)mm,(7.87±11.26)mm,(3.81±3.69)mm and(6.15±9.97)mm respectively. The skin discoloration diameter of Way A and C was significantly smaller than that of B and D, and the difference was statistically significant(P<0.05). There was no statistically significant difference between Way A and C. Way A’s pain rate (44.5%) was the lowest. Compared with Way B (59.5%), the difference was statistically significant (P<0.05). The pain scores of the four ways were (0.70±0.93), (1.13±1.29), (0.94±1.27) and (1.18±1.46) respectively. The pain score of Way A was significantly lower than that of B and D, and the difference was statistically significant (P<0.05).There was no statistically significant difference between A and C.Conclusions When needles are pulled out,and the injection areas are not pressed after the patients with acute coronary syndrome are injected for 10 s, the bruising and pain of patients can be reduced, so can the workload of the nurses.