作者：段艳芹，陈娟，赵钰

单位：

235000 安徽省淮北市人民医院；通信作者：段艳芹，E-mail：357316983@qq.com

关键词：

卒中；皮下出血；注射，皮下；抗凝药；影响因素分析

关键词（英文）：

Stroke；Subcutaneous hemorrhage；Injections，subcutaneous；Anticoagulants；Root cause analysis

中图分类号：

R 743

DOI：

DOI：10.3969/j.issn.1008-5971.2020.04.011

基金项目：

摘要：

背景　规范脑卒中患者抗凝剂皮下注射对减少皮下出血等不良反应的发生及提高患者用药依从性有重要意义。目的　分析循证护理实践规范抗凝剂皮下注射对脑卒中患者发生皮下出血的影响，并分析脑卒中患者皮下注射皮下出血发生的影响因素。方法　采用整群抽样法选取 2017 年 5—10 月入住淮北市人民医院行皮下注射低分子肝素钙的脑卒中患者 96 例，采用自行设计的一般资料问卷收集患者一般资料，包括性别、年龄、文化程度、体质指数、腹部皮肤褶皱厚度、抗凝剂用药史、联合使用抗凝剂、是否使用腰带、有无其他部位出血、患者体位及纤维蛋白原、D-二聚体。脑卒中患者抗凝剂皮下注射发生皮下出血的影响因素采用多因素 Logistic 回归分析。结果　96 例患者中 14 例（14.6%）发生皮下出血。不同性别、年龄、体质指数、腹部皮肤褶皱厚度及联合使用抗凝剂患者皮下出血发生率比较，差异有统计学意义（P<0.05）；不同文化程度、体位、纤维蛋白原、D- 二聚体及有无抗凝剂用药史、使用腰带、出现其他部位出血患者皮下出血发生率比较，差异无统计学意义（P>0.05）。多因素 Logistic 回归分析结果显示，性别（OR=1.91）、年龄（OR=55.81）、体质指数（OR=16.28）、腹部皮肤褶皱厚度（OR<0.01）、联合使用抗凝剂（OR=6.33）不是脑卒中患者抗凝剂皮下注射发生皮下出血的影响因素（P>0.05）。结论　循证护理实践规范抗凝剂皮下注射可降低脑卒中患者皮下出血的发生，其中性别、年龄、体质指数、腹部皮下皱褶厚度、联合使用抗凝剂与患者皮肤出血发生率有关，但不是其影响因素。

英文摘要：

Background　It is important to standardize the subcutaneous injection of anticoagulant in patientswith cerebral apoplexy to reduce occurrence of subcutaneous hemorrhage such as adverse reactions，and improve patients'medication compliance.Objective　To investigate effect of subcutaneous injection of anticoagulant with the evidenced-basednursing on subcutaneous hemorrhage stroke patients and its influencing factors. Methods　A total of 96 stroke patients whounderwent subcutaneous injection of anticoagulant were selected by cluster sampling method in Huaibei People's Hospital fromMay to October 2017.General data of patients were collected by self-designed general data questionnaire，including gender，age，education，BMI，abdominal skin fold thickness，history of anticoagulant use，combined use of anticoagulants，useof waistband，presence or absence of bleeding at other sites，patient position，fibrinogen，D-Dimer.Multivariate Logisticregression analysis was used toanalyze the influencing factors of subcutaneous injection of anticoagulant on subcutaneoushemorrhage stroke patients.Results　Of the 96 patients，14 cases （14.6%） had subcutaneous hemorrhage.There werestatistically significantly difference in incidence of subcutaneous hemorrhage in patients with different gender，age，BMI，abdominal skin fold thickness and combined use of anticoagulant（P<0.05）.There was no statistically significant differencein incidence of subcutaneous hemorrhage among patients with different education，body position，fibrinogen，D-Dimer，history of anticoagulant use，waistband use and other bleeding sites（P>0.05）. Multivariate Logistic regression analysis resultsshowed that，gender （OR=1.91），age （OR=55.81），BMI （OR=16.28），abdominal skin fold thickness （OR<0.01）and combined use of anticoagulant （OR=6.33） were not influencing factors of subcutaneous hemorrhage after subcutaneousinjection in stroke patients（P>0.05）. Conclusion　Subcutaneous injection of anticoagulant with the evidenced-based nursingcan reduce the incidence of subcutaneous hemorrhage in stroke patients.Gender，age，BMI，abdominal subcutaneous foldthickness and combined use of anticoagulants are related to incidence of subcutaneous hemorrhage，but are not the influencingfactors.

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