中国血液净化

中国血液净化 ›› 2018, Vol. 17 ›› Issue (05): 352-355.doi: 10.3969/j.issn.1671-4091.2018.05.015

• 护理研究 • 上一篇    下一篇

钝针扣眼交替穿刺法对于自体动静脉內瘘并发症的影响

李萍1,柴冬雪1,张玉静1,张良静1,朱佳俊1,栾伟2   

  1. 上海交通大学医学院附属仁济医院南院1.肾脏科 2.护理部
  • 收稿日期:2017-10-23 修回日期:2018-02-26 出版日期:2018-05-12 发布日期:2018-05-12
  • 通讯作者: 栾伟luanwei_renji@126.com E-mail:liping_rjny@126.com
  • 基金资助:

    上海交通大学医学院科技基金项目编号为Jyh1503

The effect of blunt needle buttonhole cannulation on the complications of autologous arteriovenous fistula

  • Received:2017-10-23 Revised:2018-02-26 Online:2018-05-12 Published:2018-05-12

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摘要： 【摘要】目的探讨不同穿刺方法对自体动静脉內瘘并发症及透析充分性的影响。方法入组91例自体动静脉內瘘的规律性血液透析患者，根据內瘘可穿刺血管长度分为A、B 组，A 组52 例(可穿刺內瘘血管长度≥5cm)、B 组39 例(可穿刺內瘘血管长度＜5cm)。再根据穿刺方式，将A 组分为钝针扣眼交替穿刺组(A1 组)26 例、绳梯向心穿刺组(A2 组)26 例；B 组分为钝针扣眼交替穿刺组(B1 组)20 例、区域离心穿刺组(B2 组)19 例。12 月后根据Kt/V、自体动静脉內瘘部位行彩色多普勒血管超声检查和临床护理观察的方法分别比较A1、A2 组，B1、B2 组透析充分性、內瘘血管狭窄、动脉瘤、血流量不足、渗血、血肿、感染、血管闭塞发生情况。结果A、B 组内0、6、12 月透析充分性无明显差别(P 值分别为A 组0.153,0.641,0.390;B 组0.345,0.345,0.523)；A 组内A2 组血管狭窄(P=0.009)、血流量不足(P =0.039)发生率高于A1 组;B 组內B2 组渗血(P =0.007)、动脉瘤(P =0.047)发生率高于B1 组。结论对于不同长度的可穿刺內瘘血管，钝针扣眼交替穿刺法能够保证透析充分性，同时可以降低动静脉內瘘血管狭窄、动脉瘤、血流量不足、渗血等并发症的发生率，是一种安全、有效的自体动静脉內瘘穿刺方法。

关键词: 自体动静脉內瘘, 穿刺方法, 扣眼穿刺

Abstract: 【Abstract】Objective To discuss the effect of different cannulation methods on the complications of autologous arteriovenous fistula and dialysis adequacy. Methods A total of 91 maintenance hemodialysis (MHD) patients with autologous arteriovenous fistula were enrolled in this study. They were divided into
group A (n=52, puncturable fistula vessel length ≥5 cm), and group B (n=39, puncturable fistula vessel length ＜5 cm). Patients in group A were subdivided into group A1 (n=26, blunt needle buttonhole cannulation) and group A2 (n=26, rope-ladder cannulation); patients in group B were subdivided into group B1 (n=20, blunt needle buttonhole cannulation) and group B2 (n=19, regional area cannulation). After 12 months, dialysis adequacy, internal fistula vascular stenosis, aneurysm, blood flow, bleeding, hematoma, infection, vascular occlusion were compared between groups A1, A2, B1 and B2. Results There was no statistical difference in dialysis adequacy between group A and group B (P＞0.05). The incidence of vascular stenosis (P=0.009) and blood flow insufficiency (P=0.039) were higher in group A2 than in group A1; the incidence of bleeding extravasation (P=0.007) and aneurysm (P=0.047) were higher in group B2 than in group B1. Conclusion Blunt needle buttonhole cannulation can reduce the incidence of complications including vascular stenosis, aneurysm, blood flow insufficiency and bleeding and ensure dialysis adequacy. So it is a safe and effective cannulation method for AVF with different length of puncturable fistula vessel.

Key words:  Autologous arteriovenous fistula, Cannulation method, Buttonhole cannulation