钝针扣眼穿刺自体动静脉内瘘在维持性血液透析治疗中的应用  

The application of blunt needle buttonhole puncture of arteriovenous fistula in maintenance hemodialysis patients

作　　者：刘伟[1] 肖萍[1] 肖佳 Liu Wei;Xiao Ping;Xiao Jia(Department of Nephrology,Dalian Municipal Central Hospital,Dalian 116033,China)

机构地区：[1]大连市中心医院肾内科,116033

出　　处：《中国实用护理杂志》2021年第27期2147-2150,共4页Chinese Journal of Practical Nursing

摘　　要：目的探讨自体动静脉内瘘的钝针扣眼穿刺法在以自体动静脉内瘘行维持性血液透析治疗中的应用以及对并发症的影响。方法连续性纳入2017年9月1日至2018年9月1日于大连市中心医院血液透析中心采用钝针扣眼穿刺动静脉内瘘行维持性血液透析治疗的患者30例作为钝针组,并根据钝针组患者的年龄、性别、原发病、透析龄,按1∶1倾向匹配同期30例采用普通锐针穿刺的维持性血液透析患者作为锐针组,随访至2019年8月31日。比较2组患者穿刺后疼痛、下机后压迫时间、感染以及内瘘闭塞的发生率,并总结钝针穿刺的方法及技巧。结果钝针组穿刺疼痛评分0分3例,1~3分25例,4~6分2例,7~10分0例;而锐针组穿刺疼痛评分0分0例,1~3分10例,4~6分20例,7~10分0例,钝针组穿刺疼痛程度显著低于锐针组,2组比较差异有统计学意义(χ^(2)值为24.156,P<0.01);下机后压迫时间,钝针组均<10 min,锐针组均>10 min;钝针组发生内瘘血管瘤0例,锐针组为21例,钝针组内瘘血管瘤发生率显著低于锐针组;钝针组穿刺针眼处发红2例,锐针组该症状出现1例。随访期内2组患者均未发生内瘘闭塞等其他严重并发症。结论与锐针穿刺法相比,钝针扣眼穿刺法可有效地减轻患者的穿刺疼痛程度,缩短下机后压迫时间,减少动脉瘤的发生,同时满足患者爱美的心理,值得临床推广。Objective To explore the application of blunt needle buttonhole puncture for arteriovenous fistula in maintenance hemodialysis patients and its effect on complications.Methods Thirty patients with maintenance hemodialysis using blunt needle buttonhole puncture for arteriovenous fistula in the hemodialysis center of Dalian Central Hospital from September 1,2017 to September 1,2018 were included as blunt needle group.Thirty patients with common sharp needle rope ladder puncture were matched 1∶1 according to age,gender,primary disease and dialysis age as sharp needle group.They were followed up until August 31,2019.The incidence of pain,compression hemostasis time,infection and internal fistula occlusion after puncture were compared between the two groups,and the methods and techniques of blunt needle puncture were summarized.Results In blunt needle group,the puncture pain score was 0 in 3 cases,1-3 in 25 cases,4-6 in 2 cases and 7-10 in 0 case.In sharp needle group,the puncture pain score was 0 in 0 case,1-3 in 10 cases,4-6 in 20 cases and 7-10 in 0 case.The puncture pain in blunt needle group was significantly lower than that in sharp needle group.The difference between the two groups was statistically significant(χ^(2) value was 24.156,P<0.01).The compression hemostasis time was less than 10 min in blunt needle group and more than 10 min in sharp needle group.There were 0 case of internal fistula hemangioma in blunt needle group and 21 cases in sharp needle group.The incidence of internal fistula hemangioma in blunt needle group was significantly lower than that in sharp needle group.There were 2 cases of redness at the puncture needle eye in blunt needle group and 1 case in sharp needle group.During the follow-up period,no other serious complications such as internal fistula occlusion occurred in both groups.Conclusions Blunt needle buttonhole puncture can effectively reduce the incidence of puncture complications,reduce the degree of puncture pain in patients,shorten the compression time from the machine,the

关 键 词：动静脉内瘘 钝针 扣眼穿刺法 

分 类 号：R473.5[医药卫生—护理学]