新动静脉内瘘穿刺中零压力改良穿刺法在血液透析患者的应用价值  

Application value of zero-pressure modified puncture method to new endovascular arteriovenous fistula in hemodialysis patients

作　　者：范容 黄路路 翁丽娜 FAN Rong;HUANG Lulu;WENG Lina(Hemodialysis Room,Haian People's Hospital,Jiangsu,Nantong 226600,China)

机构地区：[1]江苏省海安市人民医院血透室,226600

出　　处：《河北医药》2025年第2期291-294,共4页Hebei Medical Journal

基　　金：南通市基础科学研究和社会民生科技计划项目(编号:MSZ2022156)。

摘　　要：目的研究血液透析患者新动静脉内瘘穿刺中零压力改良穿刺法的应用价值。方法随机选取2020年8月至2023年7月本院387例行持续性血液透析并使用新动静脉内瘘患者分为对照组(n=194)与观察组(n=193),对照组采用传统常规穿刺法,观察组采用零压力改良穿刺法,比较2组穿刺效果。结果观察组透析期间一次性穿刺成功率93.90%高于对照组89.25%(P<0.05);观察组拔针时穿刺点渗血发生率6.40%,低于对照组11.03%(P<0.05)。2组患者透析1个疗程后血清中血肌酐(SCr)、血尿素氮(BUN)水平及尿素清除指数(KT/V)差异无统计学意义(P>0.05)。观察组穿刺时视觉模拟评分法(VAS)评分低于对照组(P<0.05);观察组透析期间焦虑自评量表(SAS)评分低于对照组(P<0.05)。观察组透析期间内瘘狭窄、内瘘阻塞、内瘘血肿、血管瘤等并发症发生率分别为3.11%、5.18%、3.11%、1.55%,低于对照组10.31%、13.40%、14.95%、7.22%(P<0.05)。结论零压力改良穿刺法应用于血液透析患者新动静脉内瘘穿刺,可提高一次性穿刺成功率,降低拔针渗血率、穿刺疼痛感,缓解焦虑情绪,减少并发症发生,且不影响透析效率,值得推广。Objective To study the application value of zero-pressure modified puncture method to new endovascular arteriovenous fistula in hemodialysis patients.Methods A total of 387 patients with continuous hemodialysis and new endovascular arteriovenous fistula from August 2020 to July 2023 were randomly divided into 2 groups.The control group(n=194)was managed by the traditional conventional puncture method,and the observation group(n=193)was intervened with the zero-pressure modified puncture method.The effect of puncture was compared between groups.Results The one-time puncture success rate was significantly higher in the observation group than that of the control group during the dialysis period(93.90%vs 89.25%,P<0.05).The incidence of blood oozing from the puncture point when removing the needle in the observation group was significantly lower than that of the control group(6.40%vs 11.03%,P<0.05).Levels of serum creatinine(SCr),blood urea nitrogen(BUN)and the KT/V index after one session of dialysis were comparable between groups(P>0.05).The Visual Analogue Scale(VAS)score and Self-Rating Anxiety Scale(SAS)score were significantly lower in the observation group than the control group during the dialysis period(P<0.05).The complication rates of endocardial fistula stenosis(3.11%vs 10.31%),endocardial fistula obstruction(5.18%vs 13.40%),endocardial fistula hematoma(3.11%vs 14.95%),and hemangioma(1.55%vs 7.22%)during dialysis in the observation group were significantly lower than those of the control group(P<0.05).Conclusion Zero-pressure modified puncture method applied to the puncture of new arteriovenous endovascular fistula in hemodialysis patients can improve the success rate of one-time puncture,reduce the rate of blood seepage from the withdrawal of the needle,the pain of puncture,alleviate anxiety,and decrease the occurrence of complications,without affecting the efficiency of dialysis,which is worth promoting.

关 键 词：血液透析 新动静脉内瘘 零压力改良穿刺法 一次性穿刺成功率 穿刺点渗血率 并发症 

分 类 号：R457[医药卫生—治疗学]