中国血液净化

中国血液净化 ›› 2015, Vol. 14 ›› Issue (11): 692-695.doi: 10.3969/j.issn.1671-4091.2015.11.013

• 护理园地 • 上一篇    下一篇

内瘘使用初期不同拔针时间对血液透析内瘘早期并发症影响的研究

徐玮,张静,朱亚梅,马逊,王蓉花,杨家慧   

  1. 南京医科大学第一附属医院（江苏省人民医院）肾内科
  • 收稿日期:2015-06-10 修回日期:2015-09-18 出版日期:2015-11-12 发布日期:2015-11-12
  • 基金资助:

    该文章得到卫生部临床重点专科建设项目基金资助为卫生部临床重点专科建设项目，编号：财社[2010]305 号；“十二五”国家科技支撑计划课题，编号：2011BA110B08；江苏省临床医学科技专项,编号:BL2014080

Withdrawal time of the punctured needles after blood access on early complications of the freshly used arteriovenous fistulas

  • Received:2015-06-10 Revised:2015-09-18 Online:2015-11-12 Published:2015-11-12

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摘要： 【摘要】目的探讨不同时间点拔针对内瘘初期使用者穿刺点止血时间、渗血率、血肿率、及内瘘并发症的影响，为延长动静脉内瘘使用时间提供依据。方法对40 例内瘘使用初期的维持性血液透析患者前10 次穿刺后下机压迫止血进行干预研究，采用群组自身对照法将400 次压迫止血分别在2 个时间点进行：一种是下机后常规立即拔针；另一种是延时拔针法，拔针时间为下机后10min。对2 个时间点拔针动静脉内瘘的止血按压时间及内瘘并发症的发生率进行比较。结果①延时拔针法在止血按压时间(7.16±2.08)min、穿刺点出血量(0.98±1.03)ml 方面优于常规立即拔针法(13.68±3.21)min、(4.15±1.55)ml，差异有统计学意义(止血按压时间t=-10.765，P＜0.001；穿刺点出血量t=-10.83，P＜0.001)。②延时拔针法渗血、皮下血肿、肢体麻木肿胀的发生率(38.00%，0.00%，6.00%)低于常规拔针法(51.50%，4.00%,22.50%)，差异均有统计学意义(渗血率χ2=7.371，P=0.009；皮下血肿率χ2=8.163，P=0.007；肢体麻木肿胀率χ2=25.823，P=0.001)。结论透析结束后保留内瘘穿刺针10min 再进行压迫止血，可明显降低内瘘使用初期患者内瘘并发症的发生率，延长内瘘的使用寿命。

关键词: 血液透析, 动静脉内瘘, 延时拔针

Abstract: 【Abstract】Objective To provide the basis for longer use of arteriovenous fistulas, we explored the withdrawal time of the punctured needles after hemodialysis on hemostasis time, exudative bleeding rate and hematoma formation rate at the punctured area, and internal fistula complications in maintenance hemodialysis (MHD) patients with freshly used internal fistulas. Methods A self- control method was carried out for 40 new MHD patients with freshly used internal fistulas. The punctured needle was withdrawn immediately or delayed for 10 min, and the punctured site was pressed for about 10 min after withdrawal. The first 10 punctures with a total of 400 punctures were analyzed. The pressed duration on punctured site and the internal fistula complications were analyzed between immediate withdrawal of the needles after hemodialysis and delayed withdrawal of the needles for 10 min. Results ①Press duration for hemostasis was (7.16±2.08)min and (13.68±3.21) min (t =-10.765, P＜0.001) for delayed and immediate withdrawal of the needles, respectively. Local bleeding volume was 0.98±1.03 ml and (4.15±1.55) ml (t=-10.83, P＜0.001) for delayed and immediate withdrawal of the needles, respectively. ②The prevalence of exudative bleeding, hematoma, and numbness/ swelling was 38.00%, 0.00% and 6.00%, respectively for delayed withdrawal of the needles, and was 51.50%, 4.00% and 22.50%, respectively for immediate withdrawal of the needles (χ2=7.371, 8.163, 25.823, respectively; P＜0.01). Conclusion The needle punctured into internal fistula should be remained in situ for 10 min after hemodialysis, and the punctured site was pressed after withdrawal. This method can significantly reduce
the incidence of early fistula complications and extend the useful period of the fistulas.

Key words: Hemodialysis, Arteriovenous fistula, Delayed withdrawal of needle