不同方法注射低分子肝素后局部和血浆肝素抗Ⅹa活性的变化

[目的]探讨采用不同注射方法注射低分子肝素(LMWH)对注射局部和血浆肝素抗Xa因子活性的影响。[方法]选取不稳定型心绞痛、非ST段抬高心肌梗死、急性ST段抬高心肌梗死病人80例,随机分为实验组和对照组各40例。对照组采用常规皮下注射方法,实验组采用改良方法,即皮下注射低分子肝素前捏起皮肤2min后进行注射,注射后持续捏起皮肤2min,于注射第1次后3.5h取血测定肝素抗Xa活性,同时观察记录每例10次皮下注射12h后局部皮肤的淤点、淤斑、血肿等并测量出血面积。[结果]实验组腹部注射局部皮肤皮下出血率及出血面积明显小于对照组(P<0.05),而血浆肝素抗Xa因子活性的变化无统计学差异。[结论]腹部皮下注射低分子肝素前后各捏起皮肤2min,可以有效地降低局部皮下出血的发生,减小出血面积。     

循证护理在皮下注射低分子肝素中的应用

[目的]探讨低分子肝素皮下注射的方法,提高药物吸收效果,减少注射中的不良反应.[方法]根据循证护理,将60例病人的120次注射按自身对照法分为两组,对照组60例次,采用传统皮下注射法;实验组60例次,排气时留0.1 mL空气,左手拇指、食指捏起腹部皮肤垂直进针.[结果]两种不同的皮下注射方法出现的不良反应经统计学分析差异有统计学意义(P<0.05),实验组优于对照组.[结论]改进后的皮下注射低分子肝素的方法有效地解决了传统注射法出现的疼痛、皮下出血等不良反应.     

改进低分子肝素注射方法与皮下出血的关系

[目的]改进低分子肝素腹部皮下注射方法。进一步降低皮下出血的发生率及减少出血面积。[方法]选择临床诊断为不稳定型心绞痛且需皮下注射低分子肝素的病人，将每例病人10次皮下注射分为对照组和改进组，进行自身对照。观察皮下出血的例次及出血面积的大小，[结果]改进组局部出血例次明显减少，未发生较大面积的瘀斑，与对照组比较均有统计学意义（P〈0．05）。[结论]采取改进的注射方法可降低皮下出血发生率及避免较大面积的出血。     

改进低分子肝素注射方法与皮下出血的关系

[目的]改进低分子肝素腹部皮下注射方法,进一步降低皮下出血的发生率及减少出血面积。[方法]选择临床诊断为不稳定型心绞痛且需皮下注射低分子肝素的病人,将每例病人10次皮下注射分为对照组和改进组,进行自身对照。观察皮下出血的例次及出血面积的大小。[结果]改进组局部出血例次明显减少,未发生较大面积的瘀斑,与对照组比较均有统计学意义(P<0.05)。[结论]采取改进的注射方法可降低皮下出血发生率及避免较大面积的出血。     

低分子肝素钙皮下注射不同方法对局部皮下出血的影响

目的探讨低分子肝素钙皮下注射不同方法对局部皮下出血发生率及出血面积的影响。方法选择本科2012年6月~2013年8月肾病综合征住院患者90例,试验组采用捏起腹壁皮肤及皮下组织形成一皱褶后垂直进针,共注射90次。对照组采用传统注射方法注射,共注射90次。结果通过观察,试验组皮下出血次数52次,平均出血面积为（1.50±0.26）cm2。对照组皮下出血次数69次,平均出血面积为（3.82±0.82）cm2,差别有显著性统计学意义（P〈0.01）。结论低分子肝素钙采用捏起腹壁皮肤及皮下组织形成一皱褶后垂直进针,可减少出血次数及缩小出血面积。     

皮下注射低分子肝素后局部压迫时间与皮下出血的关系

[目的]寻找降低皮下出血发生率的最佳压迫时间。[方法]随机选择30例行经皮冠状动脉介入术（PCI）后皮下注射低分子肝素病人,注射后按压时间分别为6min、8min、10min、12min、14min,观察皮下出血情况。[结果]皮下注射低分子肝素后压迫时间与皮下出血发生率有密切关系．局部压迫时间≥10min可以有效降低皮下出血发生率。[结果]PCI术后病人皮下注射低分子肝素后局部压迫时间≥10min为减少皮下出血及淤血的最佳时间。     

改良注射方法在预防注射低分子肝素引起皮下出血和疼痛中的应用

目的 探讨改良注射方法在预防注射低分子肝素引起皮下出血和疼痛中的作用.方法 将2011年9月～2012年3月入住我心内科病房需皮下注射低分子肝素的264例患者随机分为实验组和对照组,通过查询文献、询求专家意见,并结合患者病情和家属的实际情况,为实验组患者制定出合理可行的改良注射方案,包括:注射前热敷局部皮肤、应用提捏腹壁皮肤垂直进针法、快速推注药物、针尖拔出后保持提捏皮肤3 min等,对照组进行常规注射.结果 实验组患者皮下出血的发生率、出血面积和注射时疼痛低于常规注射组.结论 采用改良注射方法可有效地预防注射低分子肝素引起的皮下出血和疼痛.     

低分子肝素皮下注射局部压迫时间探讨

目的 探讨低分子肝素皮下注射局部压迫时间与皮下出血发生率及出血面积的关系。方法 选择脑梗死使用低分子肝素皮下注射的患者160例，将每例患者的20次皮下注射随机分为4组，每组压迫时间分别为2min、3min、4min、5min，观察皮下出血的例次及出血面积的大小。结果 低分子肝素皮下注射局部不同压迫与皮下出血存在差异，局部压迫3min，可有效地降低皮下出血发生率和较大面积出血率。结论 低分子肝素皮下注射后压迫最佳时间为3min。     

低分子肝素皮下注射局部按压时间对皮下出血的影响

目的探讨脐周皮下注射低分子肝素后按压时间对注射点皮下出血的影响。方法把脐周皮下注射低分子肝素的患者60例按住院时间先后分为实验组和对照组,实验组注射后按压10min,对照组按压5min,比较2组局部皮下瘀斑发生情况。结果对照组注射点瘀斑发生率高于实验组（P〈0．05）。结论脐周皮下注射低分子肝素后按压10min可有效地减少注射部位的皮下出血,从而提高患者对护理工作的满意度,值得在临床上进一步研究推广。     

低分子肝素皮下注射按压方法的研究

[目的 ]探讨皮下注射低分子肝素不同按压方法的效果。 [方法 ]选择使用低分子肝素的老年冠心病病人 ,采用自身对照 ,每例病人腹部注射后左侧采用常规棉签按压 ,右侧用棉球按压 ,均按压 3min ,观察皮下出血的例次及出血面积的大小。 [结果 ]两种按压方法的出血发生率比较有统计学意义 (P <0 .0 1)。 [结论 ]用棉球按压针眼 3min可以有效降低皮下出血发生率及较大面积出血率     

Heparanase neutralizes the anticoagulation properties of heparin and low-molecular-weight heparin

BACKGROUND: Heparanase is a mammalian endo-D-glucuronidase that cleaves heparan sulfate (HS) in the extracellular matrix and cell surface. It is preferentially expressed by cells of the immune system and tumor cells. Heparanase overexpression in experimental tumor models results in increased angiogenesis and metastasis. Heparin and low-molecular weight heparin (LMWH) inhibit HS degradation by heparanase. OBJECTIVE: To investigate whether heparanase cleaves heparin and LMWH, and elucidate its effect on blood coagulation. METHODS: Heparin and LMWH were incubated with recombinant heparanase and subjected to measurements of molecular size (size exclusion chromatography) and anticoagulant activity (plasma APTT-activated thromboplastin time, and anti-Xa activity). APTT was also measured in plasma samples of transgenic mice overexpressing heparanase, in comparison with control mice. RESULTS: Incubation of heparin and LMWH with heparanase resulted in degradation of these substrates, as revealed by a significant decrease in their molecular weight. This was correlated with a marked suppression of the anticoagulant activity of heparin and LMWH, as indicated by a decreased effect on APTT and anti-Xa activity, respectively, when human plasma was added. Transgenic mice overexpressing heparanase exhibited a significantly shorter APTT than control mice. CONCLUSION: Heparanase is capable of degrading heparin and LMWH, so that its overexpression by tumor cells may contribute to heparin resistance, commonly occurring in cancer patients. In view of the complexity of the currently available heparanase activity assays, we propose an indirect approach to quantify heparanase activity by measuring the decrease in plasma APTT or anti-Xa activity exerted by the enzyme under the defined conditions.     

Effects of low-molecular-weight heparin on platelets as compared with commercial heparin

Five subjects were injected with 5,000 IU of commercial heparin and low-molecular-weight heparin at an interval of 20 days after each injection. Both heparins produced the same platelet factor 4 release immediately after administration (commercial heparin 114.6 +/- 21.6 ng/ml, low-molecular-weight heparin 113.1 +/- 22.1 ng/ml). However, commercial heparin induced a more evident potentiating effect on ADP-induced platelet aggregation and was still present 60 min after injection. Low-molecular-weight heparin had a higher anti-Xa-specific activity than that determined by activated partial thromboplastin time. The opposite was true for the commercial preparation.     

Anticoagulation monitoring part 2: Unfractionated heparin and low-molecular-weight heparin

OBJECTIVE: To review the availability, mechanisms, limitations, and clinical application of point-of-care (POC) devices used in monitoring anticoagulation with unfractionated heparin (UFH) and low-molecular-weight heparins (LMWHs). DATA SOURCES: Articles were identified through a MEDLINE search (1966-August 2004), device manufacturer Web sites, additional references listed in articles and Web sites, and abstracts from scientific meetings. STUDY SELECTION AND DATA EXTRACTION: English-language literature from clinical trials was reviewed to evaluate the accuracy, reliability, and clinical application of POC monitoring devices. DATA SYNTHESIS: The activated partial thromboplastin time (aPTT) and activated clotting time (ACT) are common tests for monitoring anticoagulation with UFH. Multiple devices are available for POC aPTT, ACT, and heparin concentration testing. The aPTT therapeutic range for UFH will vary depending upon the reagent and instrument employed. Although recommended by the American College of Chest Physicians Seventh Conference on Antithrombotic and Thrombolytic Therapy, establishing a heparin concentration-derived therapeutic range for UFH is rarely performed. Additional research evaluating anti-factor Xa monitoring of LMWHs using POC testing is necessary. CONCLUSIONS: Multiple POC devices are available to monitor anticoagulation with UFH. For each test, there is some variability in results between devices and between reagents used in the same device. Despite these limitations, POC anticoagulation monitoring of UFH using aPTT and, more often, ACT is common in clinical practice, particularly when evaluating anticoagulation associated with interventional cardiology procedures and cardiopulmonary bypass surgery.     

不同肝素溶媒对血仿膜吸附法无肝素透析吸附稳定性及临床应用效果的影响

目的在前期研究应用血仿膜吸附法无肝素透析(HCHD)对高危出血患者行血液透析(HD)基础上,深入探讨不同肝素溶媒对此方法安全性和临床应用效果的影响。方法急、慢性HD高危出血患者14例。自身交叉对照设计,分别以生理盐水(NS)和5%葡萄糖(GS)为肝素溶媒,每一患者分别先后经历两次不同方式HCHD治疗。观察指标分3组进行自身和组间对照,同时观察不同溶媒对肝素吸附量和吸附稳定性的影响。结果①HCHD期间,14例患者未有加重出血的情况,3例活动性出血患者出血停止。②肝素平均吸附量GS组(4513±1446)U,NS组(4011±444)U;仅在NS冲洗液中检测到少量肝素的释放。③血活化部分凝血活酶时间(APTT)水平HCHD期间基本无变化,而同期HD组延长了274%（P<0.01）。其余指标3组间无显著性差异（P>0.05）。结论极性溶媒NS对HCHD肝素吸附量、体内凝血系统无明显影响,对于高危出血、尤其是活动性出血患者,HCHD是一种简便、安全、有效的无肝素透析方法。     

无肝素、低分子肝素及改良无肝素透析在肝硬化病人血液透析中的应用

[目的]观察无肝素、低分子肝素及改良无肝素透析在肝硬化病人血液透析中的安全性。[方法]选取88例肝硬化伴出血倾向病人,按采取透析方式的不同分为3组,A组为无肝素透析;B组为低分子肝素透析;C组为改良无肝素透析,观察病人透析前后凝血功能、透析器凝血情况及临床出血情况。[结果]3组病人透析前后凝血功能比较差异无统计学意义,A组发生凝血率显著高于B组、C组;透析后A组、C组病人出血倾向无加重表现,B组2例病人出现透析后出血倾向加重。[结论]改良无肝素透析在肝硬化病人血液透析中的应用安全性最高。     

构建动脉球囊损伤大鼠模型中低分子肝素与普通肝素的作用比较

背景:球囊对血管的损伤容易导致血栓形成,所以适当的抗凝治疗是动脉球囊损伤模型建立成功的关键. 目的:对比低分子肝素与普通肝素在建立大鼠颈动脉球囊损伤模型中的效果及作用.设计、时间及地点:随机对照动物实验,于2006-11/2007-03在深圳市人民医院临床实验中心完成.材料:雄性SD大鼠60只,体质量250～300 g;2.0 mm×20 mm经皮冠状动脉球囊成形导管及压力泵为Medtronic公司产品.方法:60只雄性SD大鼠随机分为2组,低分子肝素组与普通肝素组,每组30只,分别行左颈总动脉PTCA球囊内膜剥脱术建立动脉球囊损伤模型,低分子肝素组于术前12 h及术后24 h分别皮下注射低分子肝素600 U/kg,普通肝素组于术前经尾静脉注射普通肝素100 U/kg.主要观察指标:分别于术后即刻,3,7,14,21及28 d取5只大鼠颈动脉损伤段和对侧正常动脉行苏木精-伊红染色病理观察.结果:球囊导管损伤使大鼠颈总动脉内膜剥脱和新生内膜增生,管腔狭窄.术后7 d内膜开始增生,14～28 d增生最明显.低分子肝素组建模成功率高于普通肝素组,血栓形成几率低于普通肝素组.结论:在建立大鼠颈动脉球囊损伤模型过程中,低分子肝素较普通肝素进一步降低血栓形成的几率,提高建模成功率.