两种穿刺法对血液透析患者动静脉内瘘的应用研究

王红梅

齐齐哈尔第二机床集团有限公司职工医院血液透析科，黑龙江齐齐哈尔161000

[摘要]目的研究探讨两种穿刺法对血液透析患者动静脉内瘘的应用。方法整群选取自2012年1月—2015年2月间于该院收治的行血液透析的肾功能衰竭患者66例，随机分为两组，绳梯组采用绳梯穿刺法进行穿刺，扣眼组采用扣眼穿刺法进行穿刺，对比观察两组的穿刺效果以及患者术后并发症。结果扣眼组的穿刺疼痛相比绳梯组的次数较少，且差异有统计学意义（χ`2=71.38，P<0.05）；扣眼组的穿刺成功率也要高于绳梯组，且差异有统计学意义（χ`2=24.618，P<0.05）。扣眼组中形成血栓的患者例数为4例，而绳梯组形成血栓的患者例数为8例，两组的差异有统计学意义（χ`2=8.427，P<0.05）；扣眼组有内瘘狭窄或闭塞的患者例数为5例，而绳梯组有内瘘狭窄或闭塞的患者例数为12例，两组的差异有统计学意义（χ`2=12.715，P<0.05）。结论扣眼穿刺法相对于绳梯穿刺法具有一定优势，扣眼穿刺法可有效避免穿刺时的疼痛，可避免一些并发症的发生，如形成血栓、血管瘤以及内瘘狭窄或闭塞等，而且该方法可提高穿刺的成功率。

[关键词]血液透析;动静脉内瘘;扣眼穿刺法;绳梯穿刺法;急慢性肾衰竭

[中图分类号]R472

[文献标识码]A

[文章编号]1674-0742（2015）10（a）－0069-03

[作者简介]王红梅（1977.1-），女，山东人，本科，副主任医师，主要从事血液净化方面的工作。Application of Two Punctures in treating arteriovenous fistula in Hemodialysis Patients

Abstract[]Objective To discuss the application of two punctures in treating arteriovenous fistula in hemodialysis patients.Methods 66 patients with renal failure who were admitted to and underwent hemodialysis in this hospital between January 2012 and February 2015 were enrolled and randomized to undergo rope-ladder puncture (the rope-ladder group) and buttonhole puncture (the buttonhole group).The outcome of punctures and postoperative complications were between the two groups.Results The pain was less in the buttonhole group than in the rope-ladder group with statistically significant,χ`2=71.38, P<0.05.The successful rate was higher in the rope-ladder group with statistically significant,χ`2=24.618, P<0.05.The thrombus was found in 4 patients in the buttonhole group and in 8 patients in the rope-ladder group, and the difference was statistically significant,χ`2=8.427, P<0.05.Fistula stenosis or occlusion was found in 5 patients in the the buttonhole group and in 12 patients in the rope-ladder group, and the difference was statistically significant,χ`2=12.715, P<0.05.Conclusion The buttonhole group is superior to the rope-ladder group because it can reduce the pain and avoid complications including thrombus, hemangioma, and fistula stenosis or occlusion, as well as improve the successful rate.

收稿日期：（2015-07-05）

WANG Hong-mei

Department of Hemodialysis, Workers Hospital of Qiqihar Second Machine Tool Group Co., Qiqihar, Heilongjiang Province, 161000 China

[Key words]Hemodialysis; Arteriovenous fistula; Buttonhole puncture; Rope-ladder puncture; Acute and chronic renal failure

血液透析（hemodialysis，HD）是一种急慢性肾功能衰竭患者肾脏替代治疗的方法，随着慢性肾功能衰竭发病率的逐年升高，其治疗上也得到了极大的重视，对于该病的主要治疗方法就是血液透析，也是终末期肾衰竭的替代治疗方法，对于减轻患者的疼痛以及维持患者的生命具有重要作用，而动静脉内瘘（AVF）保证了良好的血管通路[1]，其最主要的环节还在于穿刺方法的选择，选择一项合适的穿刺方法对于内瘘的使用寿命以及患者并发症具有一定影响，目前传统的穿刺方法有绳梯法、扣眼法以及区域法三种，临床中对于区域法已经不建议采用，由于其会引起一些并发症，而绳梯法和扣眼法是目前临床中较多采用的方法，该次研究，该研究者采用扣眼法和绳梯法作对比分析，从而研究其在临床中的应用价值，现报道如下。……