张春芬 洪小英

[摘要]目的 探讨针对性护理干预在动静脉内瘘中的应用效果。方法 选取2017年1～10月我院收治的100例动静脉内瘘维持血液透析患者作为研究对象，将2017年1～5月收治的50例患者作为对照组，采用常规护理；将2017年6～10月收治的50例患者作为观察组，采用针对性护理干预。比较两组患者的一次性穿刺成功率、并发症发生率、下机压迫止血时间以及患者满意度。结果 干预3个月后，观察组患者的一次性穿刺成功率（96.0%）高于对照组（82.0%），观察组并发症发生率（2.0%）低于对照组（14.0%），差异有统计学意义（P<0.05）。观察组患者的下机压迫止血时间[（10.58±2.14）min]短于对照组[（11.54±1.76）min]，观察组患者的满意度评分[（8.76±1.32）分]高于对照组[（7.90±1.28）分]，差异有统计学意义（P<0.05）。结论 针对性护理干预能够提高钝针扣眼穿刺法的一次性穿刺成功率，缩短下机压迫止血时间，降低相关并发症以及提高患者的满意度，该方法值得在临床上推广应用。

[关键词]针对性护理干预；钝针扣眼穿刺法；动静脉内瘘；应用效果

[中图分类号] R459.5 [文献标识码] A [文章編号] 1674-4721（2018）5（a）-0184-03

[Abstract]Objective To explore the effect of targeted nursing intervention in internal arteriovenous fistulas.Methods A total of 100 cases of arteriovenous fistula and maintenance of hemodialysis treated in our hospital from January to October in 2017 were selected as the study subjects.The 50 patients treated from January to May in 2017 were as control group，who treated with routine nursing.The 50 patients treated from June to October in 2017 were as observation group，who treated with targeted nursing intervention.The success rate of one-time puncture，the rate of complications，the duration of hemostasis and compression，and satisfaction of patients were compared between the two groups.Results The success rate of one-time puncture in the observation group （96.0%） was higher than that in the control group （82.0%），the complication rate in the observation group （2.0%） was lower than that in the control group （14.0%），and the differences were statistically significant （P<0.05）.The duration of hemostasis and compression in the observation group （[10.58±2.14] min） was shorter than that in the control group （[11.54±1.76] min），the satisfaction score of the observation group （[8.76±1.32] points） was higher than that of the control group （[7.90±1.28] points），with a significant differences （P<0.05）.Conclusion Targeted nursing intervention can improve the success rate of one-time puncture with blunt needle buttonhole puncture，shorten the duration of hemostasis and compression，reduce the rate of complications，and improve patient satisfaction.This method is worthy of clinical application.

[Key words]Targeted nursing intervention；Blunt needle buttonhole puncture；Internal arteriovenous fistula；Application effect

随着医疗技术的发展和人们生活水平的提高，依赖透析生存并长期存活的慢性肾脏病终末期患者越来越多[1]。动静脉内瘘是维持性血液透析患者最为理想并长期稳定使用的血管通道，被誉为维持性血液透析患者的“生命线”，动静脉内瘘维护的好坏直接关系其使用寿命，进而影响患者的透析质量[2]。保护动静脉内瘘，提高其临床应用效果和价值，减轻患者的身心负担，成为医护人员关注的重点。大量研究结果证实[3-6]，钝针扣眼穿刺法能够有效减少血管损伤，降低内瘘相关并发症发生率，在临床上得到了广泛地应用。由于受到不同穿刺者的操作以及患者内瘘保护知识和行为欠缺等因素影响，部分患者仍然出现了感染、内瘘狭窄、疼痛等并发症[6-8]。本研究选取我院收治的100例动静脉内瘘维持血液透析患者作为研究对象，旨在针对钝针扣眼穿刺法在临床应用过程中存在的问题进行针对性干预，以期提高其临床应用效果，进而提高护理质量。……