超声在非复杂动静脉内瘘穿刺定位管理中的作用  

The effects of ultrosound examination in the management of non-complex arteriovenous fistula puncture location

作　　者：张丽红[1] 王玉柱[1] 詹申 张闻娣 肖光辉[1] ZHANG Lihong;WANG Yuzhu;ZHAN Shen(Department of Nephrology,Haidian Hospital of Beijing Ctiy,Beijing 100080,China)

机构地区：[1]北京市海淀医院(北京大学第三医院海淀院区),100080

出　　处：《河北医药》2021年第2期250-252,256,共4页Hebei Medical Journal

摘　　要：目的探讨超声在非复杂内瘘盲法穿刺定位管理中的作用。方法选择以自体动静脉内瘘(arteriovenous fistula,AVF)为通路进行规律血液透析患者127例,对AVF物理评估后盲法穿刺,穿刺顺利者透析30 min时超声评估,了解是否存在穿刺相关急性并发症,并测量穿测点内瘘深度、内径、穿刺针针尖再管腔中的位置,分析针尖位置与内瘘深度及内径的关系。结果127例中穿刺失败9例,穿刺后流量不足2例,发现血肿4例,发现渗漏3例,总并发症发生率14.17%。纳入针尖位置分析患者119例(238针),其中位于血管中间、前壁1/3、后壁1/3分别为28.99%、59.66%、11.34%,内瘘深度与针尖位置有相关性(χ2=110.26,P=0.00),当距皮距离>0.3 cm时,针尖位置更多位于血管前壁。内瘘直径与针尖位置内瘘深度与针尖位置有相关性(χ2=116.64,P=0.00),当内瘘直径<0.5 cm时,针尖位置更多位于血管后壁。结论非复杂内瘘盲法穿刺成功患者针尖处理理想状态者较少,即使非复杂内瘘也应应用超声定位理想针尖位置,以最大限度保护内瘘。Objective To investigate the effects of ultrosound examination in the management of non-complex arteriovenous fistula(AVF)puncture location.Methods A total of 127 patients with non-complex AVF who were treated by hemodialysis in our hospital from January 2020 to March 2020 were enrolled in the study.The blind puncture was performed after the physical examnation,and the patients with successful puncture underwent ultrasound examination to find out whether there were acute complications related with puncture.Moreover the depth and diameter of the puncture point as well as the position of the needle tip in the lumen were measured to analyze the correlation between the needle position and the depth and diameter of the fistula.Results Of the 127 patients,9 patients failed to puncture,2 patients had insufficient flow,4 patients had hematoma,and 3 patients had leakage,with the total incidence rate of complication being 14.17%.In the 119 patients(238 needles)who were enrolled in the needle tip position analysis,which located in in the middle of the blood vessel,anterior wall and posterior wall,accounting for 28.99%,59.66%,11.34%,respectively,and the depth of the fistula was correlated with the position of the needle(P<0.01).When the distance apart from the skin>0.3cm,the needle tip was located on the anterior wall of the blood vessel mostly,and the diameter of the fistula and the position of the needle tip were related to the depth of the internal fistula and the position of the needle tip(P<0.01).When the diameter of the internal fistula was less than 0.5cm,the position of the needle tip was located on the posterior wall of the blood vessel mostly.Conclusion There are fewer patients with ideal needle tip poisonfor non-complex AVF in spite of successful blind puncture.And ultrasound examination should be used to locate the ideal needle tip position to maximize the protection of AVF.

关 键 词：动静脉内瘘 穿刺 超声 

分 类 号：R730.41[医药卫生—肿瘤]