血液透析患者疑难自体新内瘘穿刺管理的循证实践研究  

Evidence-based practice of the puncture management in hemodialysis patients with difficult new arteriovenous fistula

作　　者：柴剑丽 吴春燕[1] 王文娟[1] 张熙熙[1] 陆明晰[1] 胡卫民[1] Chai Jianli;Wu Chunyan;Wang Wenjuan;Zhang Xixi;Lu Mingxi;Hu Weimin(Department of Hemodialysis Room,Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine,Hangzhou 310018,China)

机构地区：[1]浙江大学医学院附属邵逸夫医院血液透析室,杭州310018

出　　处：《中国实用护理杂志》2022年第13期973-979,共7页Chinese Journal of Practical Nursing

基　　金：浙江省医药卫生科技计划(2020KY167);浙江省教育厅科研项目(Y201839031);浙江大学医学院附属邵逸夫医院护理科研基金(201912HL)。

摘　　要：目的探讨基于循证的最佳实践在血液透析患者疑难自体新内瘘穿刺管理中的应用效果。方法组建团队,以基于证据的持续质量改进模式图为理论框架,运用循证实践方法得出最佳证据,制订审查指标,评估实践过程中的障碍及促进因素并采取相应的行动策略。采用便利抽样法,选取2020年2-6月在浙江大学医学院附属邵逸夫医院行血液透析治疗的30例尿毒症患者作为基线审查组,2020年9月至2021年1月在该医院行血液透析治疗的30例尿毒症患者作为后效评价组。基线审查组采用原有的疑难自体新内瘘穿刺管理方案,后效评价组采用基于最佳证据的疑难自体新内瘘穿刺管理方案。比较2组患者的内瘘一次穿刺成功率、穿刺时及透析中血肿发生率、中断治疗发生率及审查指标执行率的改变。结果后效评价组内瘘一次穿刺成功率为73.3%(22/30),高于基线审查组的36.7%(11/30),后效评价组穿刺时血肿发生率、透析中血肿发生率、中断治疗发生率分别为6.7%(2/30)、0、3.3%(1/30),低于基线审查组的33.3%(10/30)、40.0%(12/30)、40.0%(12/30),差异有统计学意义(χ2值为6.67~11.88,均P<0.05)。后效评价组审查指标执行率均高于基线审查组,差异有统计学意义(χ^(2)值为8.21~56.07,均P<0.05)。结论基于循证的最佳实践可提高疑难自体新内瘘穿刺成功率,降低内瘘血肿发生率,减少透析治疗中断发生,更好地维护患者的生命线。Objective To explore the puncture management in hemodialysis patients with difficult new arteriovenous fistula based on the finest evidence-based best practice evidence and evaluate the clinical effects.Methods A team was formed,according to theoretical framework basing on the evidence of continuous quality improvement model,the best evidence-based interventions were obtained by adopting evidence-based practice.Formulated review indicators,evaluated obstacles and promoting factors in the process of practice,and took corresponding action strategies.From February 2020 to June 2020,30 patients admitted to the dialysis center of Sir Run Run Shaw Hospital of Zhejiang University were recruited in the baseline review group by convenience sampling method.From September 2020 to January 2021,30 patients from September 2020 to January 2021 were recruited in the after-effect evaluation group.The baseline review group adopted the original difficult new arteriovenous fistula puncture management scheme,and the after-effect evaluation group adopted the difficult autologous new internal fistula puncture management scheme based on the best evidence.The success rate of one puncture of fistula,the incidence rate of hematoma during puncture and dialysis,the incidence rate of discontinuation of treatment and the compliance with examination indexes were compared in the patients before and after applying for the evidences.Results Compared with the baseline review group,the success rate of one-time puncture of internal fistula in the aftereffect evaluation group increased from 36.7%(11/30)to 73.3%(22/30),the incidence rate of hematoma during puncture and dialysis were decreased from 33.3%(10/30)to 6.67%(2/30)and 40%(12/30)to 0,the incidence rate of discontinuation of treatment were decreased from 40%(12/30)to3.33%(1/30),the difference was statistically significant(χ^(2) values were 6.67-11.88,P<0.05).The implementation rate of review indexes in the aftereffect evaluation group was higher than that in the baseline review group,and the di

关 键 词：血液透析 动静脉内瘘 疑难内瘘 穿刺 循证实践 

分 类 号：R692.5[医药卫生—泌尿科学]