中国血液净化

中国血液净化 ›› 2017, Vol. 16 ›› Issue (05): 343-346.doi: 10.3969/j.issn.1671-4091.2017.05.016

• 血管通路 • 上一篇    下一篇

影响维持性血液透析患者动静脉穿刺舒适度的因素分析及对相关不良事件影响的研究

王云燕1,封蕾1,付丽丽1   

  1. 1. 第三军医大学附属大坪医院肾内科血液净化中心
  • 收稿日期:2016-11-07 修回日期:2017-03-19 出版日期:2017-05-12 发布日期:2017-05-19
  • 通讯作者: 王云燕 382499300@qq.com E-mail:382499300@qq.com

Studies on comfortable degree of arteriovenous fistula puncture and its effects on adverse events in maintenance hemodialysis patients

  • Received:2016-11-07 Revised:2017-03-19 Online:2017-05-12 Published:2017-05-19

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摘要： 目的探讨影响维持性血液透析患者动静脉穿刺舒适度的因素及其对相关不良事件的影响。方法选取2013 年9 月～2015 年10 月在第三军医大学附属大坪医院接受维持性血液透析治疗的200 例患者，运用视觉模拟评分法将患者划分为主观感受穿刺舒适和不舒适2 组，再运用数字疼痛强度量表、穿刺肢体活动度评价表及恐惧情绪自评量表来探讨2 组患者的生活质量差异，并通过问卷调查来探讨穿刺舒适度的影响因素，最后，回顾分析整个研究过程2 组患者发生的相关不良事件。结果患者主观感受穿刺舒适的116 例，不舒适的84 例；舒适组患者疼痛评分(χ2=14.854,P=0.002)、穿刺侧活动度评分(χ2=19.277,P＜0.001)、恐惧评分(χ2=9.059, P=0.029) 显著低于主观感受不舒适患者；穿刺(β =-1.743,P=0.042)、体位(β=-1.869,P=0.043)、拔针(β=-1.961,P=0.043)、情绪(β=-1.824,P=0.027)、医护人员支持(β=-1.673, P=0.045)与血液透析患者的穿刺主观舒适度密切相关；舒适组中的血栓形成(χ2=4.886,P=0.003)、内瘘闭塞(χ2=5.109,P=0.024)、穿刺处硬结(χ2= 4.694,P=0.044)、血管狭窄(χ2=4.57,P=0.032)、血肿(χ2=4.750，P=0.029)都显著低于不舒适组。结论穿刺、体位、拔针、情绪、医护人员支持影响血液透析患者的穿刺主观舒适度，而透析患者穿刺舒适度的降低不仅可增加患者的疼痛和恐惧情绪，还降低穿刺侧活动度，从而可影响患者透析后相关不良事件的发生，这将对透析治疗质量及今后的患者生存质量产生影响。

关键词: 血液透析, 动静脉穿刺舒适度, 相关因素, 并发症, 恐惧.

Abstract: Objective To investigate the factors affecting the comfortable degree during arteriovenous fistula puncture and its effects on adverse events in maintenance hemodialysis (MHD) patients. Methods A total of 200 MHD patients were recruited at the Hemodialysis Center of Daping Hospital in Chongqing from September 2013 to October 2015. They were divided into subjective feeling of comfortable group and uncomfortable group using visual analogue scale. The qulity of life in the two groups was assessed by numerical pain rating scale, punctured limb activity form, and anxiety self-rating scale. The comfortable degree of puncture was obtained through questionnaire survey. The related adverse events during the whole investigation period in the 2 groups were then retrospectively analyzed. Results A total of 116 patients felt comfortable, and 84 patients felt uncomfortable during puncture. Pain scores (χ2=14.854, P=0.002), punctured limb activity scores (χ2=19.277, P＜0.001) and fear scores (χ2=9.059, P=0.029) were significantly lower in comfortable group than in the uncomfortable group. Puncture (β =-1.743, P=0.042), posture (β =-1.869, P=0.043), withdrawing the needle (β =- 1.961, P=0.043), emotion (β =- 1.824, P=0.027), support from medical staffs (β =-1.673, P=0.045) were closely related to the subjective comfortable feeling during puncture in MHD patients. The prevalence of thrombus formation (χ2=4.886, P=0.003), arteriovenous fistula occlusion (χ2=5.109, P=0.024), induration at puncture site (χ2=4.694, P=0.044), vascular stenosis (χ2=4.574, P=0.032) and hematoma (χ2=4.75, P=0.029) were significantly lower in comfortable group than in uncomfortable group (P<0.05). Conclusions Puncture, posture, withdrawing the needle, emotion and support from medical staffs impacted on the subjective comfortable degree during puncture in MHD patients. MHD patients with uncomfortable feeling had more pain and fear sensations and less activity at punctured side, resulting in the increase of adverse events after puncture and the decrease of dialysis effects and quality and life.

Key words: hemodialysis, arteriovenous puncture comfort, relevant factor, complications, fear.