中国血液净化

中国血液净化 ›› 2025, Vol. 24 ›› Issue (04): 323-327.doi: 10.3969/j.issn.1671-4091.2025.04.014

• 血管通路 • 上一篇    下一篇

血液透析新型单针穿刺技术在复杂自体动静脉内瘘中的应用

肖光辉    张闻娣    张丽红    詹 申    赵 彬    张 帆    王玉柱   

  1. 100080 北京，1北京市海淀医院(北京大学第三医院海淀院区)肾脏内科
  • 收稿日期:2024-08-15 修回日期:2025-01-20 出版日期:2025-04-12 发布日期:2025-04-12
  • 通讯作者: 王玉柱 E-mail:wyz4417@126.com

Application of novel single-needle puncture technique for hemodialysis patients with complex autogenous arteriovenous fistula

XIAO Guang-hui, ZHANG Wen-di, ZHANG Li-hong, ZHAN Shen, ZHAO Bin, ZHANG Fan,  WANG Yu-zhu   

  1. Department of Nephrology, Haidian Hospital (Peking University Third Hospital Haidian District Section),  Beijing 100080, China
  • Received:2024-08-15 Revised:2025-01-20 Online:2025-04-12 Published:2025-04-12
  • Contact: 100080 北京，1北京市海淀医院(北京大学第三医院海淀院区)肾脏内科 E-mail:wyz4417@126.com

摘要： 目的 探索血液透析新型单针穿刺技术在使用复杂自体动静脉内瘘的维持性血液透析(maintenance hemodialysis，MHD)患者中的安全穿刺应用。 方法 选取研究对象为2023年5月─2024年5月在北京市海淀医院肾脏内科规律透析治疗的MHD患者42人。随机数字表法分为单针血液透析治疗(观察组)，传统血液透析治疗(对照组)。比较2组间穿刺相关情况。 结果 观察组患者平均穿刺针数(t=8.446，P＜0.001)、穿刺损伤发生率(c2=9.860,P=0.007)、中心静脉导管使用率(c2=16.800，P＜0.001)、在线实时Kt/V监测平均值(t=-3.594,P＝0.001)均低于对照组。 结论 血液透析新型单针穿刺技术可有效减少穿刺针数，降低因多针穿刺导致的相关并发症的发生以及降低中心静脉导管使用率，促进复杂自体动静脉内瘘穿刺困难期间的安全使用，值得临床推广。

关键词: 单针血液透析, 新型单针穿刺技术, 维持性血液透析患者, 复杂内瘘, 安全穿刺

Abstract: Objective  To explore the application of novel single-needle puncture technique for safe puncture in the maintenance hemodialysis (MHD) patients with complex autologous arteriovenous fistulas (AVF).   Methods   A total of 42 MHD patients undergoing regular hemodialysis in the Department of Nephrology, Beijing Haidian Hospital (Peking University Third Hospital Haidian District Section) between May 2023 and May 2024 were enrolled in this study. They were divided by random table method into observation group (using single-needle technique for hemodialysis) and control group (using traditional puncture method for hemodialysis). Puncture related data were compared between the two groups.   Results   There were no statistical differences in baseline data, including age, gender, primary disease, the status of complex AVF (initial fistula, acute thrombosis secondary to stenosis, and difficulties in puncture) and central venous indwelling catheter, between the two groups at the time of enrollment (P >0.05). The total number of punctures was 43 in observation group, lower than that of 81 times in control group, with the average number of punctures statistically lower in observation group than in control group (t =8.446, P >0.001). The incidence of puncture injury was statistically lower in observation group than in control group (c2=9.860, P=0.007). The rate of indwelling catheter usage was statistically lower in observation group than in control group (c2=16.800, P <0.001). The average value of online real-time Kt/V monitoring was statistically lower in observation group than in control group (t =-3.594, P=0.001).   Conclusion  The novel single-needle puncture technique can effectively reduce the number of punctures, the complications caused by multiple needle punctures, and the rate of central venous catheter usage, and ensure safe puncture to the complex AVF during its difficult puncture period. Therefore, this method is worthy of clinical promotion.

Key words: Single-needle puncture for hemodialysis, Novel single-needle puncture technique, Maintenance hemodialysis patient, Complex autologous arteriovenous fistula, Safe puncture

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