老年不稳定心绞痛及伴有衰弱患者皮下注射低分子肝素后出血的危险因素分析  

Risk Factors of Bleeding after Subcutaneous Injection of Low-molecular-weight Heparin in Elderly Patients with Unstable Angina Pectoris and Asthenia

作　　者：吴琪[1] 季梅丽[1] 张蓉[1] 王丹蕾[1] 夏佩佩 Wu Qi;Ji Meili;Zhang Rong;Wang Danlei;Xia Peipei(Department of Geriatrics,Nanjing Hospital Affiliated to Nanjing Medical University(Nanjing First Hospital),Nanjing 210000)

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)老年医学科,南京210000

出　　处：《国际老年医学杂志》2024年第2期147-151,共5页International Journal of Geriatrics

基　　金：江苏省卫生健康委科研课题(BJ19006)。

摘　　要：目的 分析老年不稳定心绞痛伴有衰弱患者皮下注射低分子肝素后出血的危险因素。方法 选取2020年6月—2023年6月在南京医科大学附属南京医院(南京市第一医院)老年医学科与心内科住院治疗的老年不稳定心绞痛伴衰弱患者,按照是否发生皮下出血将其分为皮下出血组(90例)和对照组(90例),对比两组年龄、性别、体质量指数(BMI)等一般资料,以及合并疾病及注射方法等变量。多因素logistic回归分析皮下注射低分子肝素后发生皮下出血的危险因素。结果 皮下出血组患者BMI、注射低分子肝素后进行注射点按压的患者比例及皮下脂肪厚度均显著低于对照组,差异具有统计学意义(P<0.05);多因素logistic回归分析显示,皮下脂肪厚度低、BMI较低及拔针后未进行注射点按压均是患者使用低分子肝素皮下注射后发生皮下出血风险的独立危险因素(P<0.05)。结论 皮下脂肪厚度低、BMI较低及拔针后未进行注射点按压是老年不稳定心绞痛及伴有衰弱患者使用低分子肝素皮下注射后发生皮下出血风险的独立危险因素,在临床应用低分子肝素时应注意控制血压或增加按压时间,进而降低患者皮下出血的发生风险。Objective To analyze the risk factors of bleeding after subcutaneous injection of low-molecular-weight heparin in elderly patients with unstable angina pectoris and weakness.Methods Elderly patients with unstable angina pectoris and weakness who were hospitalized in the Department of Geriatrics and the Department of Cardiology of Nanjing Hospital Affiliated to Nanjing Medical University(Nanjing First Hospital)from June 2020 to June 2023,they were randomly divided into subcutaneous hemorrhage group(n=90)and control group(n=90)according to whether subcutaneous hemorrhage occurred.General data such as age,gender,body mass index(BMI),as well as combined diseases and injection methods were compared between the two groups.Multivariate logistic regression was performed to analyze the risk factors for subcutaneous hemorrhage after subcutaneous injection of low-molecular-weight heparin.Results The BMI,proportion of patients who underwent compression after injection of low-molecular-weight heparin,and subcutaneous fat thickness of patients in the subcutaneous hemorrhage group were significantly lower than those in the control group,with statistical significance(P<0.05).Multivariate logistic regression results showed that low subcutaneous fat thickness,low BMI and no pressing after needle withdrawal were independent risk factors of subcutaneous hemorrhage after subcutaneous injection of low-molecular-weight heparin in patients(P<0.05).Conclusion Low subcutaneous fat thickness,low BMI and no injection point compression after needle withdrawal are independent risk factors for the risk of subcutaneous hemorrhage in elderly patients with unstable angina pectoris and associated weakness after subcutaneous injection of low-molecular-weight heparin.In the clinical application of low-molecular-weight heparin,attention should be paid to control blood pressure or increase compression time,thereby reducing the risk of subcutaneous hemorrhage in patients.

关 键 词：不稳定心绞痛 衰弱 低分子肝素 皮下出血 危险因素 

分 类 号：R541.4[医药卫生—心血管疾病]