摘要
目的:比较普通穿刺、钝针扣眼穿刺和新型钝针扣眼穿刺三种动静脉内瘘穿刺法在血液透析患者中的应用效果。方法:将60例采用动静脉内瘘作为血管通路的血液透析患者随机分为A组(普通穿刺)、B组(钝针穿刺)、C组(新型钝针穿刺)各20例。6个月后,比较三组患者穿刺相关并发症、各生化指标和透析充分性;并对影响穿刺并发症的相关因素进行多变量COX回归模型分析。结果:C组穿刺点剧痛、内瘘狭窄的发生率低于A、B组(P<0.05),而内瘘血肿、假性动脉瘤的发生率低于A组(P<0.05);6个月后C组患者C反应蛋白(CRP)水平低于A、B组(P<0.05),血红蛋白(HGB)水平高于A、B组(P<0.05),组间URR、Kt/V水平比较差异无统计学意义(P>0.05);多变量COX回归模型分析:影响内瘘穿刺并发症的主要因素是透析龄、HGB、CRP。结论:新型钝针扣眼穿刺法能明显降低透析患者穿刺点血肿、假性动脉瘤、血管狭窄的发生率,减轻透析患者的微炎症状态,且不影响透析充分性;内瘘穿刺的并发症可能与透析龄、HGB、CRP水平密切相关。
Objective：To compare the application effect among three kinds of internal fistula puncture （conventional puncture,blunt needle puncture and improved buttonhole blunt needle puncture） in patients with hemodialysis. Methods ：60 patients （taking arteriovenous fistula as a vascular access for hemodialysis ） were randomly divided into group A （ conventional puncture, n = 20 ） , group B （ blunt needle puncture, n = 20 ） and group C （ improved buttonhole blunt needle puncture, n = 20 ）. After 6 months, the puncture - related complications, the biochemical indicators and dialysis adequacy were compared among the three groups. And the related factors affecting the complications of puncture were analyzed by multivariate COX regression model. Results ： The incidence of severe pain at the puncture point and fistula stenosis was lower in group C than that in group A and B （ P 〈 0.05 ） ; the incidence of fistula hematoma and pseudoaneurysm was lower in group C than group A （P 〈 0.05 ） ;After 6 months, the levels of CRP of the patients in group C were lower than group A and B （P 〈 0. 05 ） ; the levels of HGB were higher in group C than group A and B （ P 〈 0.05 ） ; the differences of URR and kt / V were not statistically significant between the groups （ P 〉 0.05 ）. The multivariable Cox regression model analysis showed that the main factors affecting the com- plications of internal fistula puncture were the duration of dialysis,HGB and CRP levels. Conclusion ：The improved buttonhole blunt needle puncture method can significantly reduce the incidence of hematoma around puncture site, pseudoaneurysm and vascular stenosis and alle- viate the microinflammation state in dialysis patients,which does not affect the dialysis adequacy. The complications of internal fistula puncture may be related to duration of dialysis, HGB and CRP levels.
出处
《齐鲁护理杂志》
2015年第14期20-22,共3页
Journal of Qilu Nursing
关键词
血液透析
新型钝针扣眼法
动静脉内瘘
穿刺并发症
Hemodialysis
Improved buttonhole blunt needle puncture method
Arteriovenous fistula
Complications of puncture
