中国血液净化

中国血液净化 ›› 2018, Vol. 17 ›› Issue (05): 356-359.doi: 10.3969/j.issn.1671-4091.2018.05.016

• 护理研究 • 上一篇    下一篇

B 超下画图计划绳梯穿刺在动静脉内瘘患者中的应用与分析

高菊林1,梁珊珊1,杜晶晶1,刘小敏1,蒋红利1   

  1. 1. 西安交通大学第一附属医院血液净化科
  • 收稿日期:2017-12-26 修回日期:2018-03-10 出版日期:2018-05-12 发布日期:2018-05-12
  • 基金资助:

    陕西省自然科学基础研究计划项目，项目编号：2017JM8141 西安交通大学第一附属医院课题，编号: 2017HL-10

Application of rope ladder puncture under the guidance of color Doppler ultrasonography in hemodialysis patients with arteriovenous fistula

  • Received:2017-12-26 Revised:2018-03-10 Online:2018-05-12 Published:2018-05-12

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摘要： 【摘要】目的探讨B 超下画图计划绳梯穿刺对血液透析患者的应用效果分析。方法选择西安交通大学第一附属医院2017 年1～6 月收治的首次使用动静脉内瘘(arteriovenous fistula，A-V fistula)的血液透析患者共128 例为研究对象。按照初次使用动静脉内瘘的顺序将患者随机分为对照组和观察组两组。对照组采用传统绳梯穿刺法，观察组采用B 超下画图计划绳梯穿刺法，比较两组患者的一次性穿刺成功率、绳梯穿刺技术执行率、患者满意率、联机在线尿素清除指数(online clearance monitoring，Online Kt/V)达标率、穿刺中度疼痛率及内瘘并发症发生率，进行6 个月随访比较。结果观察组患者的满意率100%，高于对照组患者的满意率73% ( χ2 = 10.012, P = 0.001)；观察组绳梯穿刺技术执行率100%，高于对照组绳梯穿刺技术执行率46% ( χ2 = 16.123, P＜0.001)；观察组Online Kt/V 达标率95%，高于对照组Online Kt/V 达标率80% ( χ2 = 7.479, P = 0.008)；观察组的穿刺中度疼痛发生率3%，低于对照组的穿刺中度疼痛发生率30% ( χ2 = 9.729,  P=0.003)；观察组内瘘并发症发生率1%，低于对照组内瘘并发症发生率20%(χ2=8.279, P=0.005)。观察组一次性穿刺成功率97%与对照组的一次性穿刺成功率96%差异无统计学意义 ( χ2 = 0.187, P = 0.657)。结论B 超下画图计划绳梯穿刺能帮助护士更好的实践绳梯穿刺技术，减少穿刺造成的血管并发症，降低患者中度疼痛率，从而延长内瘘使用寿命，提高患者透析效果和治疗满意度。

关键词: 血液透析, 动静脉内瘘, B超下画图计划绳梯穿刺, 穿刺并发症

Abstract: 【Abstract】Objective To investigate the effect of color Doppler ultrasonography on the application of rope ladder puncture for arteriovenous fistula in hemodialysis patients. Methods We recruited 128 hemodialysis patients first using arteriovenous fistula for blood access in the period from January 2017 to June 2017. They were randomly divided into control group and observation group according to the sequence of initial use of arteriovenous fistula. In the control group, the traditional rope ladder method was used. In the observation group, color Doppler ultrasonography was used to draw the rope ladder puncture site. The success rate of once puncture, implementation rate of rope ladder puncture technique, patient satisfaction rate, compliance rate of online clearance monitoring (online Kt/V), moderate pain rate during puncture and fistula complication rate were followed-up for 6 months to analyze the differences between the two methods. Results The satisfaction rate of observation group was higher than that of control group (100% vs. 73%, χ2=10.012, P=0.001). The execution rate in observation group was much higher than that in control group (100% vs. 46%, χ2=16.123, P＜0.001). The online Kt/V compliance rate in observation group was significantly higher than that in control group (95% vs. 80%, χ2=7.479, P=0.008). The incidence of moderate puncture pain (3% vs. 30%, χ2=9.729, P=0.003) and arteriovenous fistula complications (1% vs. 20%, χ2=8.279, P=0.005) in observation group were also much lower than those in control group. There was no significant difference in the success rate of once puncture between the observation group and the control group (97% vs. 96%, χ2=0.187, P=0.657). Conclusion The rope ladder puncture under the guidance of color Doppler ultrasonography can help nurses better manipulate the puncture technique, reduce the vascular complications caused by puncture, ameliorate moderate pain rate of the patients, prolong the service life of the internal fistula, and improve dialysis effect and treatment satisfaction of the patients.

Key words: hemodialysis, arteriovenous fistula, Rope ladder puncture under the guidance of color Doppler ultrasonography, Puncture complication