超声引导下绘制动-静脉内瘘穿刺图谱在内瘘穿刺中的应用  

Effect of ultrasound-guided mapping for arteriovenous fistula puncture in internal fistula puncture

作　　者：黄梅丽 李珍 秦月兰[1] 陈杏 HUANG Meili;LI Zhen;QIN Yuelan;CHEN Xing(Hunan Provincial People’s Hospital,Changsha 410016,China)

机构地区：[1]湖南省人民医院//湖南师范大学附属第一医院,湖南长沙410016

出　　处：《现代医院》2022年第5期807-810,814,共5页Modern Hospitals

基　　金：湖南省卫生健康委一般资助课题(202114010632)。

摘　　要：目的探讨超声引导下绘制动-静脉内瘘穿刺图谱在内瘘穿刺中的应用价值,以期为安全、有效的内瘘穿刺提供新的思路及参考依据。方法选取2019年10月—2020年4月湖南省人民医院血液净化中心血液透析患者初次使用自体动静脉内瘘穿刺,自体动静脉内瘘均为腕部自体内瘘(桡动脉-头静脉)94例,随机采用随机数字表法分为干预组及对照组各47例。对照组采取盲法穿刺,干预组经超声引导下绘制动-静脉内瘘穿刺图谱辅助实施穿刺。统计两组一次性穿刺成功率、穿刺皮肤至见回血固定针头时间(<3 s、3~5 s、>5 s)、并发症发生率、中度疼痛分布情况。结果干预组一次性穿刺成功率(97.87%)高于对照组(82.98%)(P<0.05);干预组穿刺皮肤至见回血固定针头时间优于对照组(P<0.05);干预组疼痛分布情况优于对照组(P<0.05);干预组并发症发生率(4.26%)低于对照组(19.15%)(P<0.05)。结论采取超声引导下绘制动-静脉内瘘穿刺图谱辅助实施穿刺,可显著提升一次性穿刺成功率,缩短穿刺皮肤至见回血固定针头时间,降低并发症发生风险,且减轻患者疼痛感。Objective To explore the effect of ultrasound-guided mapping for arteriovenous fistula puncture in internal fistula puncture so as to provide new ideas and reference for safe and effective internal fistula puncture.Methods A total of 94 hemodialysis patients with autologous arteriovenous fistulas(radial artery-cephalic vein)who treated autogenous arteriovenous fistula puncture for the first time were selected in our hospital from October 2019 to April 2020.The patients were randomly divided into intervention group(n=47)and control group(n=47)by the random number table.The control group was subjected to blind puncture,while the intervention group was treated with arteriovenous fistula puncture assisted by ultrasound-guided mapping.The success rate of one-time puncture,the time from skin puncture to blood return and needle fixation(<3 s,3-5 s,>5 s),the incidence of complications and the distribution of moderate pain were compared between the two groups.Results The success rate of one-time puncture in the intervention group was higher than that in the control group(97.87%vs.82.98%,P<0.05).The time from skin puncture to blood return and needle fixation in the intervention group was shorter than that in control group(P<0.05).The pain distribution in the intervention group was better than that in the control group(P<0.05).The complication rate in the intervention group was significantly lower than that in the control group(4.26%vs.19.15%,P<0.05).Conclusion The ultrasonic-guided mapping for arteriovenous internal fistula puncture can significantly improve the success rate of one-time puncture as well as shorten the time of skin puncture to blood return and needle fixation.It can also reduce the risk of complications and the pain of patients.

关 键 词：内瘘穿刺 超声引导 动-静脉内瘘穿刺图谱 

分 类 号：R473.5[医药卫生—护理学] R459.5[医药卫生—临床医学]