中国血液净化

中国血液净化 ›› 2017, Vol. 16 ›› Issue (10): 711-714.doi: 10.3969/j.issn.1671-4091.2017.010.018

• 血管通路 • 上一篇    下一篇

血液透析内瘘扣眼穿刺技术临床应用效果观察

赵敬娜1,李华1,苏香彪1,柳竹青1,张东亮1   

  1. 1. 北京大学国际医院
  • 收稿日期:2017-03-07 修回日期:2017-08-27 出版日期:2017-10-12 发布日期:2017-10-12
  • 通讯作者: 张东亮 zhangdongliang@pkuih.edu.cn E-mail:zhangdongliang@pkuih.edu.cn
  • 基金资助:

    北京大学国际医院院内科研基金资助(编号：YN2016ZD05 )

Observational study on clinical effects of blunt buttonhole technique in hemodialysis

  • Received:2017-03-07 Revised:2017-08-27 Online:2017-10-12 Published:2017-10-12

PDF

834

摘要： 目的对比钝针“扣眼”(buttonhole, BH)穿刺与锐针“绳梯”(rope ladder, RL)穿刺在维持性血液透析(maintenance hemodialysis, MHD)患者中应用的临床效果。方法选取使用自体动静脉内瘘进行MHD 治疗的患者26 例进行回顾性分析，BH 组11 例患者采用钝针BH 穿刺法，RL 组15 例患者采用锐针RL 穿刺法。对比随访13 个月期间2 组患者在发生感染、穿刺成功率、穿刺点渗血发生率、平均有效血流量和尿素清除指数(Kt/V)的情况。结果2 组患者均未发生局部与系统性感染。BH 组共进行2073 例次钝针穿刺操作，RL 组2392 次锐针穿刺操作，BH 组患者一次穿刺成功率99.5%显著高于RL 组的96.0%(χ2=57.591，P＜0.001)，穿刺点渗血率2.9%明显低于RL 组的4.1%(χ2=5.008，P=0.029)，2 组间平均有效血流量(285.2±21.1ml/min 对300.2±24.6ml/min，t=-1.673，P=0.107)和Kt/V 差异无显著性(1.4±0.2对1.5±0.2，t=-0.256，P=0.800)。结论BH 钝针穿刺与RL 锐针穿刺相比具有穿刺成功率高、拔针后出血几率低的优势，而且并不增加感染的发生。

关键词: 血液透析, 动静脉内瘘, 穿刺, 钝针, 感染

Abstract: Objective To compare the clinical effects between buttonhole (BH) puncture by blunt needle and rope ladder (RL) puncture by sharp needle in maintenance hemodialysis (MHD) patients. Methods Patients with native arteriovenous fistula (AVF) for MHD treated in our blood purification center from Feb. 2016 to Feb. 2017 (13 months) were followed up. There were 11 patients punctured by BH technique (group BH) and 15 patients punctured by RL technique (group RL) during hemodialysis. The ratio of infection, success of puncture, bleeding of puncture point, average effective blood flow volume, and urea clearance index
(Kt/V) were compared between the two groups. Results No infection events happened in both groups. There were 2,073 times puncture in group BH and 2,392 times puncture in group RL. The successful puncture rate in group BH was significantly higher than that in group RL (99.5% vs. 96.0%, χ2=57.591, P＜0.001). The incidence of bleeding in group BH was significantly less than that in group RL (2.9% vs. 4.1%, χ2=5.008, P=0.029). There were no significant differences in average effective blood flow volume (285.2±21.1 ml/min vs.300.2±24.6 ml/min, t=-1.673, P=0.107) and Kt/V (1.4±0.2 vs. 1.5±0.2, t=-0.256, P=0.800). Conclusion BH technique using blunt needle for AVF puncture shows the benefits in terms of higher puncture success rate, less bleeding rate and lower risk of infection.

Key words: Hemodialysis, Arteriovenous fistula, Puncture, Blunt needle, Infection