双静脉穿刺作为临时性血管通路在血液透析中的应用  

The application of double venipuncture as temporary vascular access in hemodialysis

作　　者：孙淑清[1] 陈今[1] 王琰[1] 林曰勇[1] 余毅[1] 

机构地区：[1]南京军区福州总医院血液净化科,350025

出　　处：《中国医师进修杂志》2014年第7期57-59,共3页Chinese Journal of Postgraduates of Medicine

摘　　要：目的 探讨双静脉穿刺代替深静脉置管作为临时性血管通路在血液透析中应用的可行性.方法 上臂中下1/3处扎止血带,用内瘘针直接穿刺肘正中静脉,穿刺成功后,上臂止血带换成弹力绷带,模仿献血员献血时手部握皮球或橡皮圈,不断做握球运动,作动脉端引血,静脉端选择另一侧肘正中静脉或下肢大隐静脉穿刺.分别随机选取已使用双静脉穿刺透析和深静脉置管透析2周以上的各30例患者（双静脉组、深静脉组）,透析前采血测量生化指标及肾功能.结果 1282例新进入血液透析治疗的患者,已有成熟动静脉内瘘的患者8例,占0.6％（8/1 282）,深静脉置管542例,占42.3％（542/1 282）,采用双静脉穿刺732例,占57.1％（732/1 282）.血流量180 ～200 ml/min,使用时间1～2个月.两组血清肌酐、尿素氮、钙、磷及二氧化碳结合力比较差异无统计学意义（P＞0.05）.结论 大部分患者双静脉穿刺血流量可以满足透析需要,双静脉穿刺操作简单,无通路再循环,并发症少,且可减少深静脉置管,是一个较理想的临时性血管通路.Objective To explore the feasibility of the double venipuncture instead of central venous catheter as a temporary vascular access in hemodialysis.Methods The upper arm below the 1/3 was tied a tourniquet,and fistula needle directly punctured the vein in the middle of the elbow.After the success of the puncture,elastic bandage was replaced by a tourniquet,and the ball movement was done by imitating the blood donation member for blood donation at hand gripping a ball or elements as the artery blood lead.Another elbow vein or lower limb saphenous vein was punctured.Thirty patients using double venipuncture dialysis or central venous catheter dialysis 2 weeks or more were randomly selected into each group,and biochemical and renal function was measured before dialysis.Results All of 1 282 patients who were newly into the blood dialysis,mature arteriovenous fistula was in 8 patients （0.6%,8/1 282）,deep venipuncture to insert the central venous catheter was in 542 patients（42.3%,542/1 282）,using the double venipuncture was in 732 patients （57.1%,732/1 282）.The flow of blood was 180-200 ml/min,the avalible time was 1-2 months.The serum creatinine,blood urea nitrogen,calcium,phosphorus and carbon dioxide combining power had no significant difference between two groups （P 〉 0.05）.Conclusions The majority of patients with double venipuncture blood flow can satisfy the need of dialysis.Because the operation is simple,no recycling and may reduce the deep venipuncture,it is an ideal temporary vascular access.

关 键 词：尿毒症 血液透析滤过 血管通路 

分 类 号：R459.5[医药卫生—治疗学]