贾冬芳

【摘要】目的：探討与观察基于倾向性护理在疑难动静脉内瘘穿刺中的应用效果。方法：选择2020年12月—2022年11月在医院进行疑难动静脉内瘘穿刺的86例处于终末期的肾病患者，取随机1：1掷硬币法，行分组处理。组别为倾向组与对照组。所有患者都给予绳梯式穿刺，观察时间为3个月，对照组在穿刺期间给予常规护理，倾向组在对照组护理的基础上给予倾向性护理，记录与观察两组患者预后。结果：倾向组护理3个月期间的局部硬结、内瘘团阻、皮下血肿、内瘘狭窄等并发症发生率为4.65%，对照组为18.60%，倾向组与对照组相比明显降低（P<0.05）。两组护理3个月后的内瘘血流速度高于治疗前（P<0.05），静脉压低于治疗前（P<0.05），倾向组与对照组护理3个月后的瘘血流速度与静脉压对比也有显著差异（P<0.05）。结论：基于倾向性护理在疑难动静脉内瘘穿刺中的应用能减少患者的并发症发生率，改善患者的内瘘血流速度与静脉压状况。

【关键词】倾向性护理；疑难动静脉内瘘；绳梯式穿刺；并发症；内瘘血流速度

Observation on application of nursing based on tendency in difficult arteriovenous fistula puncture

JIA Dongfang

First Peoples Hospital of Tianshui， Tianshui， Gansu 741000， China

【Abstract】Objective： To explore and observe the application effect of nursing based on tendency in difficult arteriovenous fistula puncture. Methods： 86 patients with end-stage renal disease who underwent difficult arteriovenous fistula puncture in the hospital from December 2020 to November 2022 were selected and grouped in a randomized 1：1 coin toss method. The groups were tendency group and control group. All patients underwent rope ladder puncture， and the observation time was 3 months. The control group was given routine nursing during the puncture period， and the tendency group was given nursing based on tendency on the basis of the control group. The prognosis of the two groups of patients was recorded and observed. Results： The incidence rate of complications such as local induration， internal fistula block， subcutaneous hematoma， and internal fistula stenosis during the 3-month nursing period in the tendency group was 4.65%， and it was 18.60% in the control group. Compared with the control group， the incidence rate of the tendency group was significantly lower （P<0.05）. After 3 months of nursing， the blood flow velocity of the internal fistula in the two groups was higher than before treatment （P<0.05）， and the venous pressure was lower than before treatment （P<0.05）. There was also a significant difference in the blood flow velocity of the fistula and venous pressure between the tendency group and the control group after 3 months of nursing （P<0.05）. Conclusion： The application of tendentious nursing in difficult arteriovenous fistula puncture can reduce the incidence of complications and improve the blood flow velocity and venous pressure of patients.

【Key Words】Nursing based on tendency； Difficult arteriovenous fistula； Rope ladder puncture； Complications； Blood flow velocity of the internal fistula

随着终末期肾病患者的增多，当前血液透析人群逐年增加，使得这些患者的生存时间更长。实施血液透析治疗的前提是拥有良好的血管通路，同时也保证了治疗效果[1]。当前临床上使用率较高的血管通路为自体动静脉内瘘（Autogenous arteriovenous fistula，AVF），由于血液透析是一种需长期进行的治疗方式，因此需要反复穿刺自体动靜脉内瘘[2]。而疑难动静脉内瘘的穿刺要求技术比较高，稍有不慎会导致患者穿刺部位的疼痛，同时增加了静脉压过高、血流量不足等风险，不利于透析治疗，为此对于护理的要求也比较高[3-4]。倾向性护理能够针对患者的病情特征、患者特征、手术操作进行科学与对症的护理服务，从而促进改善患者的临床状 态[5-6]。本文观察与探讨了基于倾向性护理在疑难动静脉内瘘穿刺中的应用价值，以改善患者的预后。……