中国血液净化

中国血液净化 ›› 2023, Vol. 22 ›› Issue (05): 396-400.doi: 10.3969/j.issn.1671-4091.2023.05.018

• 护理研究 • 上一篇    

动静脉内瘘扣眼穿刺处内膜增生特点及停止穿刺的效果观察

张 尧   王 霄   杜楠楠   王辰玮    张瑞斌    高庆贞   

  1. 250013 济南，1山东第一医科大学附属中心医院肾脏病/血液净化科
  • 收稿日期:2022-11-28 修回日期:2023-02-12 出版日期:2023-05-12 发布日期:2023-05-12
  • 通讯作者: 高庆贞 E-mail:gaoqingzhen@163.com
  • 基金资助:
    山东省济南市卫生健康委员会科技计划项目（2017-1-23）

Characteristics of intimal hyperplasia at the buttonhole puncture segments of arteriovenous fistula and the effect of discontinuing the puncture

ZHANG Yao, WANG Xiao, DU Nan-nan, WANG Chen-wei, ZHANG Rui-bin, GAO Qing-zhen   

  1. Department of Nephrology and Blood Purification, The Central Hospital Affiliated to Shandong First Medical University, Jinan 250013, China
  • Received:2022-11-28 Revised:2023-02-12 Online:2023-05-12 Published:2023-05-12
  • Contact: 250013 济南，1山东第一医科大学附属中心医院肾脏病/血液净化科 E-mail:gaoqingzhen@163.com

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摘要： 目的 研究动静脉内瘘钝针扣眼穿刺处内膜增生的演变特征，分析内膜增生的可能发病机制，探求合理的干预措施。 方法 运用多普勒超声观察动静脉内瘘扣眼穿刺处内膜增生情况，测定增生组织大小，总结其形态学特点；将穿刺处出现内膜增生的扣眼依照是否继续穿刺，分为继续使用组、停止使用组，动态观察穿刺处内膜增生的变化，并采用Spearman相关分析内膜增生与患者临床资料的相关性。 结果 共纳入39例患者、82个扣眼。超声检查显示扣眼穿刺处血管前后壁均可出现内膜增生，并表现出不同的特点。初次检查时钝针扣眼组内膜增生发生率为54.9%，高于传统锐针组(χ2=103.197，P＜0.001)。Spearman相关分析结果显示扣眼穿刺处内膜增生与穿刺时间呈正相关(r=0.211，P=0.001)。 1年内的前后对比结果显示：继续使用组(n=28)内膜增生进行性加重，增生组织长、宽、厚值较前增加(t=-4.030、-3.093、-2.454，P值分别为＜0.001、0.005、0.021)；停止使用组(n=21)增生组织逐渐消退，增生组织长、宽值较前减小(t=3.140、3.084，P=0.005、0.006)。 结论 扣眼穿刺处容易出现内膜增生，内膜增生程度随穿刺时间延长逐渐加重，及时停止穿刺是缓解内膜增生的有效措施。

关键词: 动静脉内瘘, 扣眼穿刺, 钝针, 内膜增生, 多普勒超声

Abstract: Objectives  To study the pathological course of intimal hyperplasia at the blunt needle buttonhole puncture segments of arteriovenous fistula (AVF), analyze the possible pathogenesis of the intimal hyperplasia, and find out the effective intervention measures.  Methods   Doppler ultrasound was used to observe the intimal hyperplasia at the buttonhole puncture segments of AVF, measure the size of the hyperplastic area, and describe its morphological characteristics. Patients with intimal hyperplasia at the buttonhole puncture segment were divided in to continuous use group and discontinuous use group according to whether or not the puncture was continuously used. The changes of intimal hyperplasia at the puncture segments were dynamically observed. Spearman correlation was used to analyze the correlation between intimal hyperplasia and clinical data of the patients.  Results  A total of 39 patients with 82 buttonholes were included in this study. Ultrasound examinations showed that intimal hyperplasia appeared at the anterior and posterior blood vessel walls of the buttonhole puncture segments with various morphological characteristics. At the initial examination, the incidence of intimal hyperplasia at the blunt needle buttonhole puncture segments was 54.9%, significantly higher than the incidence in the traditional sharp needle puncture group (χ2=103.197, P＜0.001). Spearman correlation analysis showed that the intimal hyperplasia at the buttonhole puncture segments was positively correlated with the puncture time (r=0.211, P=0.001). In the continuous use group, the intimal hyperplasia (n=28) aggravated progressively, with significant increase of length, width and thickness of the hyperplastic area after one year (t=-4.030, -3.093 and -2.454 respectively; P＜0.001, =0.005 and 0.021 respectively). While in the discontinuous use group (n＝21), the intimal hyperplasia subsided gradually, with significant decrease of length and width of the hyperplastic area after one year (t=3.140 and 3.084 respectively; P=0.005 and 0.006 respectively).  Conclusions Intimal hyperplasia is liable to occur at the vascular walls of buttonhole puncture segments, and the degree of intimal hyperplasia gradually increases with the prolongation of puncture time. Discontinuing the puncture is an effective measure to alleviate the intimal hyperplasia.

Key words: Arteriovenous fistula, Buttonhole puncture, Blunt needle, Intimal hyperplasia, Doppler ultrasound

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