中国血液净化

中国血液净化 ›› 2017, Vol. 16 ›› Issue (02): 134-137.doi: 10.3969/j.issn.1671-4091.2017.02.016

• 护理园地 • 上一篇    下一篇

血液透析用留置针临床使用的效果观察

苏香彪1,蒋雯雯1,张东亮1   

  1. 1. 北京大学国际医院
  • 收稿日期:2016-08-19 修回日期:2016-12-02 出版日期:2017-02-12 发布日期:2017-02-12
  • 通讯作者: 张东亮 zdlycy@sina.com E-mail:zdlycy@sina.com
  • 基金资助:

    北京大学国际医院院内科研基金资助(编号：YN2016ZD05)

Observational study on clinical effects of trocar used in hemodialysis

  • Received:2016-08-19 Revised:2016-12-02 Online:2017-02-12 Published:2017-02-12

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摘要： 目的对比观察透析用留置针与普通钢制锐针进行血液透析(hemodialysis，HD)治疗的临床使用效果。方法选择26 例使用自体动静脉内瘘(arteronevous fistulae，AVF)进行维持性HD 治疗的患者，随机分为2 组进行留置针穿刺和钢制锐针穿刺的交叉试验，每种穿刺针各进行6 次HD 治疗后交换，对比不同穿刺针HD 过程中各项参数，包括：血液治疗量(treatment blood volume,TBV)、超滤除水量(ultrafiltration volume,UFV)、尿素清除率(urine reduction ratio，URR)、溶质清除指数(Kt/V)、有效血泵流量(effective blood volume,EBV)、实际透析液流量(actual dialysate volume,ADV)、超滤速率(ultrafiltration,UFR)、动脉端压力(pressure of arterial,PA)、静脉端压力(pressure of venous,PV)、跨膜压(transmembrane pressure,TMP)。结果使用留置针进行HD 治疗时，其Kt/V(1.57±0.37 对1.49±0.34，F=4.144，P=0.043)、EBV[(260.2±45.1)ml/min 对(251.6±28.6)ml/min，F=13.742，P＜0.001]、PA[(-149.3±55.0)mmHg 对(-177.7±53.6)mmHg，F=15.048，P＜0.001]显著高于钢制锐针，而PV 则显著低于钢制锐针[(105.8±39.4)mmHg 对(123.6±38.0)mmHg，F=12.272，P＜0.001]。结论透析用留置针比刚直锐针在HD治疗中更容易获取充足的体外循环血液流量并增加透析充分性。

关键词: 血液透析, 动静脉内瘘, 留置针, 穿刺

Abstract: Objective To compare the clinical effects on hemodialysis (HD) using trocar and conventional steel puncture needles. Methods A total of 26 patients with arterovenous fistula (AVF) for HD were enrolled in this study. They were randomly divided to 2 groups. Patients in group one used trocar needles and patients in group two used conventional steel needles in the first stage of 6 HD sessions. The puncture needles were exchanged between the two groups in stage 2, which also included 6 HD sessions. HD parameters including treatment blood volume (TBV), ultrafiltration volume (UFV), urine reduction ratio (URR), urea clearance index (Kt/V), effective blood volume (EBV), actual dialysate volume (ADV), ultrafiltration (UFR), pressure of arterial (PA), pressure of venous (PV), transmembrane pressure (TMP) were compared between sessions using the two kinds of needles. Results Kt/V [(1.57±0.37) vs. (1.49±0.34), F= 4.144, P=0.043], EBV [(260.2 ± 45.1)ml/min vs. (251.6 ± 28.6)ml/min, F=13.742, P＜0.001] and PA [(-149.3±55.0)mmHg vs. (-177.7±53.6)mmHg, F=15.048, P＜0.001] were much higher in the HD sessions using trocar needles than in those using conventional steel needles. PV value was less in trocar sessions than in conventional steel needle sessions [(105.8±39.4)mmHg vs. (123.6±38.0)mmHg, F=12.272, P＜0.001]. Conclusion Trocar needles can improve the blood volume access and increase the clearance ratio of urea, as compared with those using conventional steel needles.

Key words: Hemodialysis, Arterovenous fistulae, Trocar, Puncture