扣眼穿刺技术在血液透析患者疑难动静脉内瘘穿刺中的应用  

Application of blunt needle buttonhole puncture technologyin puncture of difficult arteriovenous fistula in hemodialysis patients

作　　者：郑晓艳[1] 蔡淑华[1] 吴碧金[1] 林菊英[1] 方莉[1] ZHENG Xiao-yan(Department of blood purification,Fujian provincial hospital,Fuzhou,Fujian,350001,China)

机构地区：[1]福建省立医院血液净化科,福建福州350001

出　　处：《齐齐哈尔医学院学报》2020年第2期225-227,共3页Journal of Qiqihar Medical University

摘　　要：目的探讨钝针扣眼穿刺法在维持性血液透析患者疑难动静脉内瘘穿刺中的应用效果。方法选择2017年7月-2018年6月在本院使用动静脉内瘘作为血管通路,门诊规律血液透析,动静脉内瘘使用≥3个月,动静脉内瘘可供穿刺的血管长度≤2 cm,有认知能力、无精神障碍,同意参加研究但属于疑难穿刺的血液透析患者共58例作为研究对象,采用随机数表法分为观察组和对照组。观察组26例采用钝针扣眼穿刺法进行穿刺,对照组32例采用绳梯穿刺法进行穿刺。分别对两组患者的一次穿刺成功率、血管瘤形成、血管狭窄、血栓形成、透析中针眼渗血、拔针后止血时间、尿素清除指数(Kt/V值)进行统计分析。结果观察组共穿刺2 061例次,对照组共穿刺2460例次,一次穿刺成功率(99.1%,90.1%),假性动脉瘤(1例,15例),血管狭窄(2例,11例),透析中针眼渗血(49例,204例),拔针后平均止血时间[(7.4±1.5)分钟,(13.2±4.8)分钟)],尿素清除指数(Kt/V值)平均值(1.6±0.2)和(1.4±0.2),组间比较差异有统计学意义(P<0.05)。结论对于血管位置深,可供穿刺长度短的疑难动静脉内瘘,采用钝针扣眼穿刺技术,一次穿刺成功率大大提高,可降低假性动脉瘤、血管狭窄等内瘘并发症发生率,同时缩短拔针后止血时间,减少穿刺点渗血的发生,保证充足的血流量,延长动静脉内瘘的使用寿命,提高透析充分性,具有良好的临床应用价值。Objective To investigate the effect of blunt needle puncture buttonhole puncture technology on puncture of difficult arteriovenous fistula in maintenance hemodialysis patients.Methods From July 2017 to June 2018, 58 cases of difficult puncturehemodialysis patients were divided into observation group and control group by random number method. They took arteriovenous fistula as vascular access, received regular outpatient hemodialysis, the use of arteriovenous fistula for more than 3 months, arteriovenous fistula for puncture length less than 2 cm, with normal cognitive ability and without mental disorders, and agreed to participate in the study.The 26 patients in the observation group were punctured with blunt needle buttonhole puncture, while the 32 patients in the control group were punctured with rope ladder puncture. The success rate of puncture, hemangioma formation,vascular stenosis, thrombosis, bleeding of needle eye during dialysis, hemostasis time after needle extraction and urea clearance index(Kt/V) were analyzed.Results There were 2061 punctures in buttonhole group and 2460 punctures in rope ladder group. The success rate of puncture was 99.1% and 90.1%, respectively. There were one case of pseudoaneurysms, 2 cases of vascular stenosis, and 49 cases of needle bleeding in dialysis in buttonhole group, and the number of those complications in rope ladder group were 15, 11 and 204, respectively. The average time of hemostasis after needle extraction was(7.4±1.5) minutes and(13.2±4.8) minutes, and the average value of urea clearance index(Kt/V value) were 1.6±0.2 and 1.4±0.2, there were significant differences between the two groups(P<0.05).Conclusions For difficult arteriovenous fistulas with deep vascular position and short puncture length, the success rate of one puncture could be greatly improved by using blunt needle buttonhole puncture technique, reduce the occurrence of complications of internal fistula such as pseudoaneurysm and vascular stenosis,shorten the time of hemostasis after needle extr

关 键 词：血液透析 动静脉内瘘 扣眼穿刺 

分 类 号：R473[医药卫生—护理学]