中国血液净化

中国血液净化 ›› 2018, Vol. 17 ›› Issue (08): 539-541.doi: 10.3969/j.issn.1671-4091.2018.08.008

• 血管通路 • 上一篇    下一篇

智能掌上超声诊断仪在疑难动静脉内瘘穿刺中的应用

傅丽丽1,黄龙1   

  1. 1. 陆军军医大学第三附属医院肾内科血液净化中心
  • 收稿日期:2018-03-07 修回日期:2018-05-27 出版日期:2018-08-12 发布日期:2018-08-12

The application of intelligent handheld ultrasound diagnostic instrument for difficult puncture of arteriovenous arteriovenous fistula

  • Received:2018-03-07 Revised:2018-05-27 Online:2018-08-12 Published:2018-08-12

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摘要： 【摘要】目的  探讨智能掌上超声诊断仪在血液透析患者疑难动静脉内瘘血管穿刺中的应用价值。方法   选择2016 年10 月～2016 年12 月行维持性血液透析的疑难动静脉内瘘患者22 例，作为对照组，选择2017 年10 月～2017 年12 月行维持性血液透析的疑难动静脉内瘘患者17 例，作为观察组。2 组患者均由固定经验丰富的护士穿刺，对照组采取传统穿刺法，先评估，再凭经验盲穿。观察组使用智能掌上超声诊断仪，对血管进行评估、定位、标识、穿刺。观察2 组患者内瘘穿刺成功率、疼痛评分、内瘘穿刺相关并发症的发生率。结果  对照组患者内瘘穿刺成功率为88.77%，观察组患者内瘘穿刺成功率为94.57%，差异有统计学意义(χ2= 20.609, Ｐ＜0.001)。观察组患者疼痛评分为3.51±2.03 分，明显低于对照组患者疼痛评分5.07±2.38 分，差异有统计学意义(t=3.833, Ｐ＜0.001)。观察组患者发生皮下血肿(χ2=17.762, Ｐ＜0.001)、渗血(χ2=27.333, Ｐ＜0.001)、穿刺点硬结(χ2=21.056, Ｐ＜0.001)均低于对照组，差异均有统计学意义。结论采用智能掌上超声诊断仪，可以提高疑难动静脉内瘘穿刺成功率，减轻患者疼痛，降低内瘘穿刺相关并发症的发生。

关键词: 彩超, 血液透析, 动静脉内瘘, 疑难血管, 穿刺

Abstract: 【Abstract】Objective To explore the application of intelligent handheld ultrasound diagnostic instrument for the diagnosis of arteriovenous fistula (AVF) status in maintenance hemodialysis (MHD) patients. Methods We recruited 22 MHD patients with complicated AVF treated between October 2016 and December 2016 in the Hemodialysis Center of our hospital as the control group, and 17 MHD patients with complicated AVF treated between October 2017 and December 2017 in this center as the observation group. The AVF puncture for blood access for the two groups of patients was performed by experienced nurses. For patients in the control group, traditional puncture method, i.e. observation first and then blind puncture of the AVF was adopted; for those in the observation group, evaluation, position, marking and puncture of the AVF were conducted by using a intelligent handheld ultrasound diagnostic instrument. The success rate of AVF puncture, pain score, and the rate of puncture-related complications were compared between the two groups. Results The success rate of puncture was 88.77% in the control group and 94.57% in the observation group (χ2=20.609, P＜0.001). The pain score of the observation group was 3.51±2.03, significantly lower than that of the control group 5.07±2.38 (t=3.833, P＜0.001). Subcutaneous hematoma (χ2=17.762, P＜0.001), bleeding at puncture site (χ2=27.333, P＜0.001), and induration at puncture site (χ2=21.056, P＜0.001) were alsolower in the observation group than in the control group. Conclusion AVF puncture with the help of intelligent handheld ultrasound diagnostic instrument can improve the success rate of AVF puncture, alleviate pain, and reduce the AVF puncture-related complications.