中国血液净化

中国血液净化 ›› 2022, Vol. 21 ›› Issue (05): 381-384.doi: 10.3969/j.issn.1671-4091.2022.05.018

• 护理研究 • 上一篇    

15G内瘘穿刺针在维持性血液透析患者中应用的效果及安全性

关艳宁1,胡娜娜1,崔政1,王梅2,罗莉1   

  1. 1北京大学国际医院 2北京大学人民医院
  • 收稿日期:2021-08-30 修回日期:2022-01-12 出版日期:2022-05-12 发布日期:2022-05-12
  • 通讯作者: 罗莉 E-mail:luoli@pkuih.deu.cn
  • 基金资助:
    北京大学国际医院科研基金(YN2019HL05)

Fistula cannulation using a 15G needle in maintenance hemodialysis patients: the safety and efficacy 

GUAN Yan-ning1, HU Na-na1, CUI Zheng1, WANG Mei2, LUO Li1   

  1. Dialysis Center, Department of Nephrology, Peking University International Hospital, Beijing 102206, China; 2Department of Nephrology, Peking University People’s Hospital, Beijing 100044, China
  • Received:2021-08-30 Revised:2022-01-12 Online:2022-05-12 Published:2022-05-12

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摘要： 目的：观察15G 动静脉内瘘（arteriovenous fistula, AVF）穿刺针在维持性血液透析（maintenance hemodialysis，MHD）患者中应用的有效性和安全性。方法：选取2020年11月~2021年2月在北京大学国际医院透析中心行MHD治疗时间＞1年、AVF成熟、常规血流速≥350ml/min的患者26例。采用自身对照方法，先后使用16G内瘘穿刺针和15G内瘘穿刺针，设置血流速（blood flow rate，BFR）350ml/min，使用统一的透析器（FX80）分别进行6次高通量血液透析（high flux hemodialysis, HFHD）治疗，观察有效血流速(effective blood flow rate, EBFR)、动脉压(arterial pressure, AP)、静脉压(venous pressure, VP)、跨膜压(transmembrane pressure, TMP)，在线尿素清除率（online clearance monitor，OCM）及用采血法计算单室尿素溶质清除指数（spKt/Vurea）。记录不同型号穿刺针对患者疼痛程度的影响及拔针后压迫时间（time of compression，TC）及治疗过程中不良事件。结果：在设置血流速为350ml/min时使用15G内瘘穿刺针的EBFR[（322.63±15.41）比（315.36±11.42）ml/min, t＝-2.776，P＝0.013]和OCM-Kt/V（1.18±0.13 比 1.14±0.14，t＝-2.178， P＝0.045）均高于16G内瘘穿刺针。使用15G内瘘穿刺针的AP[（-129.61±25.71）比（-191.27±20.05）mmHg, t＝-8.441，P＜0.001]和VP [（139±11.77）比（167.81±10.23）mmHg, t＝8.822，P＜0.001] 绝对值均低于16G穿刺针。使用15G穿刺针透析结束后压迫止血时间较16G穿刺针延长[（60.19±23.25）比（54.99±20.51）min, t＝3.188，P＝0.004]，疼痛评分无明显差异[（1.56±1.29）比（1.93±1.61）, t＝1.336，P＝0.200]。结论：在血液透析患者血流速≥350ml/min的情况下，使用15G穿刺针比16G穿刺针能增加有效血流速从而增加患者的透析充分性，疼痛评分无差异，但拔针后止血时间延长。

关键词: 血液透析, 动静脉内瘘, 内瘘穿刺针, 透析充分性

Abstract: Objective To observe the efficacy and safety of fistula cannulation using a 15G needle in maintenance hemodialysis (MHD) patients.  Methods  This was a prospective and self-control study. A total of 26 MHD patients with mature arteriovenous fistula and routine blood flow rate of ≥350ml/min were enrolled in this study. All patients underwent high-flux hemodialysis for 6 continuous sessions, and blood flow rate was set at 350ml/min using a 16G or a 15G puncture needle. During each session, we monitored the effective blood flow rate (EBFR), arterial pressure (AP), venous pressure (VP), transmembrane pressure (TMP), online urea clearance using an online clearance monitor (OCM), and calculated single-chamber urea solute clearance index (spKt/V) by blood sampling. We recorded the impact of 16G and 15G needles on the time of compression (TC) after needle removal, pain score of the patients, and the related adverse events in the follow-up period.  Results  When the pump speed was set at 350ml/min using a 15G puncture needle, EBFR [(322.63±15.41)ml/min vs. (315.36±11.42)ml/min, t=-2.776，P=0.013] and OCM-spKt/V [(1.18±0.13) vs. (1.14±0.14), t=-2.178, P=0.045] were higher than those using a 16G puncture needle; AP [(-129.61±25.71)mmHg vs. (-191.27±20.05)mmHg, t=-8.441, P＜0.001] and VP [(139±11.77)mmHg vs. (167.81±10.23)mmHg, t=8.822, P＜0.001]were significantly lower than those using a 16G puncture needle. The time of compression after the needle removal using a 15G needle was longer than that using a 16G needle [(60.19±23.25) min vs. (54.99±20.51)min, t=3.188, P=0.004]. There was no significant difference in score of pain [(1.56±1.29) vs. (1.93±1.6), t=1.336, P=0.200].  Conclusions  When the blood flow rate was set at ≥350ml/min, the use of a 15G needle can significantly increase the real blood flow compared with that of a 16G needle, thereby improving the dialysis adequacy. There is no significant difference in score of pain, but the time of compression after needle removal was longer in patients using a 15G needle than in those using a 16G needle.

Key words:  Hemodialysis, Arteriovenous fistula, Needle, Dialysis adequacy

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