刘金玲　张智辉　艾文佳　林少芒

【摘要】 目的 总结肾功能衰竭尿毒症患者行人工血管动静脉内瘘手术后的临床护理方法。方法 对35例肾功能衰竭尿毒症患者行人工血管动静脉内瘘手术， 术后进行密切观察及精心护理。观察患者临床疗效。结果 35例患者中， 术后3个月内血管通畅率100%， 3个月后血栓形成3例， 6个月后血栓形成5例， 均行手术取栓术， 术后血管通畅。2例感染患者经治疗痊愈。3周后均可在人工血管进行临床穿刺行血液透析治疗。结论 人工血管动静脉内瘘通路对于自身血管条件差或无法再做自体血管造瘘的患者是非常理想的一条血液透析通路， 而术后早期需要做好细致的观察和护理， 后期则需要医护患三方共同协作对其进行维护， 保证其通畅性。

【关键词】 人工血管；动静脉内瘘；肾功能衰竭；尿毒症；护理

DOI：10.14163/j.cnki.11-5547/r.2016.33.083

Postoperative observation and nursing of artificial blood vessel for internal arteriovenous fistula LIU Jin-ling， ZHANG Zhi-hui， AI Wen-jia， et al. Department of Vascular Surgery， Second Affiliated Hospital of Guangzhou Medical University， Guangzhou 510260， China

【Abstract】 Objective To summarize clinical nursing measures after artificial blood vessel internal arteriovenous fistula surgery for patients with kidney failure uremia. Methods A total of 35 patients with kidney failure uremia received artificial blood vessel internal arteriovenous fistula surgery， along with postoperative close observation and nursing. Their clinical effects were observed. Results The 35 cases had vascular patency rate as 100% within 3 months after operation. There were 3 thrombosis cases after 3months and 5 cases after 6 months， and they all received operative thrombectomy， which ensured vascular patency. There were 2 infected cases cured after treatment， who received hematodialysis by clinical puncture for treatment after 3 weeks. Conclusion Artificial blood vessel internal arteriovenous fistula is an ideal hematodialysis approach for patients with poor vascular condition or incapacity for receiving autologous vascular fistula. Postoperative short-term observation and nursing， and long-term cooperation by doctor， nurse and patient are essential for keeping vascular patency.

【Key words】 Artificial blood vessel； Internal arteriovenous fistula； Kidney failure； Uremia； Nursing

慢性肾功能不全尿毒症患者需要长期依赖血液透析维持生命， 内瘘是肾衰竭患者永久的血管通路， 是透析治疗守卫生命线， 临床上通常选用自体动静脉建立血液透析通路， 但由于患者自身血管条件差或自体血管造瘘后出现闭塞无法行透析治疗， 则需要改用人工血管移植物建立理想的血液透析通路。本科2015年5月～2016年5月为35例肾衰竭患者行人工血管动静脉内瘘手术， 术后在精心治疗和护理下取得良好的效果， 现将护理体会报告如下。

1 资料与方法

1. 1 一般资料 对2015年5月～2016年5月本院血管外科的35例肾衰竭患者行人工血管动静脉内瘘手术。……