基于肝功能分级的按压时间优化对肝癌患者皮下注射低分子肝素后局部出血的影响

The Influence of Compression Time Based on Liver Function Adjustment on Local Bleeding in Liver Cancer Patients Receiving Subcutaneous Injection of Low Molecular Weight Heparin

摘要: 目的：低分子肝素是常用的抗凝药物，但其使用可能有引起出血的风险，尤其是肝功能异常患者。肝脏是药物代谢和凝血因子生成的关键器官，肝功能异常可导致低分子肝素清除率降低和凝血功能受损，从而增加出血风险。本研究旨在通过随机对照试验探索基于肝功能调整的按压时间对肝癌患者皮下注射低分子肝素后局部出血事件的影响。方法：2020年7月至2022年7月在本院接受治疗的480例肝癌患者，根据肝功能分为I组(正常或轻度肝功能损伤)和II组(中度至重度肝功能损伤)，组内患者随机分配至不同按压时间组(0、1、3分钟)。评估患者皮下注射低分子肝素后局部出血事件发生率及出血直径大小。结果：正常或轻度肝功能损伤肝癌患者，按压时间对减少出血事件无显著影响。然而，在中度至重度肝功能损伤肝癌患者中，按压组患者局部出血阳性率明显低于不按压组(44.17%比68.33%，P < 0.001)，最大出血直径显著小于不按压组患者(3.46 mm比5.16 mm，P < 0.001)。进一步研究显示，1分钟按压组患者局部出血发生率及最大出血直径均显著低于3分钟按压组患者，分别为30.00%比58.33% (P = 0.003)、2.36 mm比4.25 mm (P < 0.001)。结论：肝功能异常是影响皮下注射低分子肝素后局部出血的重要因素。对于中度至重度肝功能损伤的肝癌患者，皮下注射低分子肝素后进行1分钟的按压有助于减少局部出血事件的发生率及严重程度。本研究为肝功能异常患者的抗凝治疗提供了个体化护理建议。

Abstract: Objective: Low molecular weight heparin (LMWH) is a commonly used anticoagulant, but its use carries the risk of bleeding, especially in patients with abnormal liver function. The liver is a critical organ for drug metabolism and the production of clotting factors. Abnormal liver function can lead to reduced clearance of LMWH and impaired coagulation, thereby increasing the risk of bleeding. This study aims to explore the impact of adjusted compression time based on liver function on local bleeding events in hepatocellular carcinoma (HCC) patients after subcutaneous injection of LMWH through a randomized controlled trial. Methods: From July 2020 to July 2022, 480 HCC patients treated at our hospital were divided into Group I (normal or mild liver dysfunction) and Group II (moderate to severe liver dysfunction) based on liver function. Patients within each group were randomly assigned to different compression time groups (0, 1, and 3 minutes). The incidence of local bleeding events and the size of bleeding diameter were assessed after subcutaneous injection of LMWH. Results: In HCC patients with normal or mild liver dysfunction, compression time had no significant effect on reducing bleeding events. However, in patients with moderate to severe liver dysfunction, the positive rate of local bleeding was significantly lower in the compression group compared to the non-compression group (44.17% vs. 68.33%, P < 0.001), and the maximum bleeding diameter was significantly smaller in the compression group (3.46 mm vs. 5.16 mm, P < 0.001). Further analysis showed that the 1-minute compression group had a significantly lower incidence of local bleeding and a smaller maximum bleeding diameter compared to the 3-minute compression group, with rates of 30.00% vs. 58.33% (P = 0.003) and 2.36 mm vs. 4.25 mm (P < 0.001), respectively. Conclusion: Abnormal liver function is a significant factor influencing local bleeding after subcutaneous injection of LMWH. For HCC patients with moderate to severe liver dysfunction, applying 1 minute of compression after subcutaneous injection of LMWH helps reduce the incidence and severity of local bleeding events. This study provides individualized nursing recommendations for anticoagulant therapy in patients with abnormal liver function.