无痛穿刺技术在血液净化病人中的应用  

Application of painless puncture technique in patients with blood purification

作　　者：廖元江[1] 高小玲[1] 金南慧[1] 郭勇[1] 马爱景[1] 文燕[1] 刘娅[1] 刘华春[1] 张艳[1] 

机构地区：[1]重庆市第九人民医院肾内科,重庆北碚400700

出　　处：《现代医药卫生》2010年第16期2442-2443,共2页Journal of Modern Medicine & Health

摘　　要：目的:观察无痛穿刺在血液净化病人中的效果及对循环的影响。方法:将穿刺病人随机分组。Ⅰ组复方利多卡因乳膏麻醉后穿刺,未造瘘组(Ⅰa,15例),造瘘组(Ⅰb,15例);Ⅱ组病人直接穿刺,未造瘘组(Ⅱa,15例),造瘘组(Ⅱb,15例),每组穿刺150次。穿刺后用数字评定量表[1,2]评价疼痛,监测穿刺前后心率(HR)、血压(BP)。结果:疼痛评分Ⅰ组低于Ⅱ组(未造瘘组P<0.01,造瘘组P<0.05),Ⅱb低于Ⅱa组(P<0.01);Ⅱa组穿刺后HR、BP升高(P<0.01),Ⅱa组穿刺前HR、BP较Ⅰa组高,Ⅰ组及Ⅱb组穿刺前后HR、BP无变化。结论:造瘘和无痛穿刺可减轻病人穿刺的痛苦及血流动力学改变,提高病人舒适性;造瘘联合无痛穿刺更佳。Objective：To investigate the effects of painless puncture on the circulation system and analgesia of the patients with blood purification.Methods：The patients receiving blood purification were randomly divided into 4 groups（n=150 for each）.The groupⅠ received puncture after anesthesia with compound lidocaine cream,including subgroupsⅠa（15 cases） and Ⅰb（15 cases） with or without fistula,the groupⅡwas directly punctured in subgroupsⅡa（15 cases） and Ⅱb（15 cases） with or without fistula.150 times of puncture were conducted in each group.After treatment,the patients were evaluated for the pain using numerical rating scale.The changes of heart rate（HR） and blood pressure（BP） were monitored.Results：The pain score in the group Ⅰ was less than that in the group Ⅱ（P〈0.01 for the comparison between Ⅰa and Ⅱa;P〈0.05 for the comparison between Ⅰb and Ⅱb）.The pain score in subgroup Ⅱb was lower than that in the subgroup Ⅱa（P〈0.01）.The HR and BP values were significantly increased after puncture in the subgroup Ⅱa（P〈0.01）.Both values before puncture were higher in the subgroup Ⅱa as compared with those in the subgroup Ⅰa.Additionally,no marked difference was observed between before and after puncture in Ⅰand Ⅱb subgroups.Conclusion：Fistula and pain-free puncture can significantly reduce the pain of puncture and hemodynamic changes in the patients with blood purification.The combination of fistula and painless puncture offers better advantages.

关 键 词：复方利多卡因乳膏 局部麻醉 血液净化 疼痛 循环 

分 类 号：R45[医药卫生—治疗学]