两种穿刺方法对血液透析患者动静脉内瘘的影响  

Effect of two puncture methods on the arteriovenous fistula of hemodialysis patients

作　　者：严贺[1] 金凤兰[1] 童辉[1] 刘慎薇[1] 徐钢[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院血液净化中心,武汉430030

出　　处：《中华现代护理杂志》2012年第34期4195-4198,共4页Chinese Journal of Modern Nursing

摘　　要：目的探讨两种穿刺方法对血液透析患者穿刺难度、患者穿刺紧张度和穿刺疼痛度以及内瘘外观的影响，为血液透析患者内瘘扣眼穿刺的临床应用提供理论依据。方法将33例自体动静脉内瘘患者分为两个阶段，基础阶段采用绳梯式穿刺，跟踪阶段采用扣眼穿刺，分别记录基础阶段和跟踪阶段的2，3，6，12，18个月的患者重复穿刺次数、穿刺紧张度、穿刺疼痛度、压迫止血时间、渗血次数、感染、动脉瘤形成、血栓形成。结果（1）与绳梯式穿刺相比，扣眼穿刺后，穿刺难度降低，重复穿刺次数减少，重复穿刺次数从（0．8±1．4）降至（0．3±0．6），差异有统计学意义（t=1．89，P：0．0438）；（2）与绳梯式穿刺相比，扣眼穿刺能够明显降低患者紧张度，VAS分数从（2．9±2．4）分降至（1．3±1．2）分，差异有统计学意义（t=3．42，P=0．0010）；（3）扣眼穿刺时穿刺疼痛的VAS评分（1．6±2．0）分相对于绳梯式穿刺的疼痛度（2．3±2．2）分有所减轻，但是差异无统计学意义（t=1．35，P=0．181O）；（4）扣眼穿刺没有增加压迫止血时间，没有增加发生感染，动脉瘤和血栓的概率，能够有效保护内瘘外观。结论对于可供穿刺长度较短的、穿刺难度较大的和穿刺紧张度高的动静脉内瘘患者采用扣眼穿刺比目前临床上广泛使用的绳梯式穿刺能够更加有效降低穿刺难度，提高穿刺成功率，降低患者穿刺的紧张度和保护内瘘外观。Objective To explore the effect of two puncture methods on the puncture difficulty, puncture ease and puncture-related pain of hemodialysis patients so as to provide theoretical proof for the clinical application of button-hole method. Methods Totals of 33 cases were divided into baseline stage and follow-up stage. In baseline stage, rope-ladder puncture method was applied, and in follow-up stage, button-hole puncture method was used. Repeated puncture times, puncture stress, puncture-related pain, compression time after needle removal, infiltration occurrence after needle removal, infection occurrence, aneurysm formation, thrombosis formation were recorded. Results Comoared with rune-ladder puncture, button-hole method decreased puncture difficulty and reduced the repeated puncture times. And the incidence of bad sticks was significantly decreased from （0.8± 1.4） to （0.3± 0.6）, with significant difference （ t = 1.89, P = 0. 043 8 ）. Button-hole method reduced the puncture stress, and the VAS score was reduced from （2.9 ± 2.4） to （ 1.3 ± 1.2）, with significant difference （t = 3.42, P = 0. 001 0）. Button-hole method abated the puncture-related pain, but no significant difference was found between them [ （ 1.6± 2.0） vs （2.3± 2.2） ], with no difference （t = 1.35 ,P =0. 181 0）. Button-hole method protected the fistula appearance efficiently, and not increased the infection occurrence, aneurysm formation and thrombosis formation. Conclusions For a patient with a limited space to puncture, or with frequent puncture, or with severe puncture stress, button-hole method is good method, because it can decrease puncture difficulty and reduce repeated puncture times, reduce the puncture stress and protect the fistula appearance efficiently.

关 键 词：动静脉瘘 扣眼穿刺 穿刺紧张度 穿刺疼痛度 

分 类 号：R473.5[医药卫生—护理学]