摘要
目的探讨顺向穿刺法对血液透析患者动静脉瘘早期启用的影响。方法按时间顺序将 5 5例初次使用内瘘的血液透析患者随机分成两组 ,实验组选择内瘘肘部头静脉或贵要静脉作为动脉出路向心方向穿刺 ,选择同侧下肢大隐静脉或任意一条非瘘静脉作为静脉回路。对照组 (常规穿刺法 )动脉出路距瘘口近侧头静脉离心方向穿刺 ,静脉回路选择动脉端 5cm以上任意静脉向心穿刺 ,比较两组一次穿刺成功率、血流量、内瘘堵塞率、皮下血肿发生率。结果动脉端实验组一次穿刺成功率为 95 .71 % ,明显高于对照组 (为 80 .30 % ) (P <0 .0 1 )。动脉端皮下血肿发生率实验组为 4 .2 9% ,明显低于对照组 (为 1 2 .1 2 % ) (P <0 .0 1 ) ,静脉端两组一次穿刺成功率、皮下血肿发生率差异无显著性意义 (P >0 .0 5 )。实验组内瘘堵塞率为 3.5 7% ,明显低于对照组 (为 2 5 .93% ) (P <0 .0 5 )。实验组透析中血流量可达 2 0 0ml/min以上 ,为 82 .82 % ,对照组为 77.2 7% ,差异无显著性意义 (P <0 .0 5 )。
Objective To explore the effect on the early application of arteriovenous internal fistula for patients with hemodialysis through catacline puncture. Methods 55 patients with hemodialysis and initial applying internal fistula were divided into two groups. In experimental group, elbow and Guiyao vein were selected as artery exit for centripetal puncture. The section were selected and randomly divided into two groups. Patients in the control group took lower limb vein at the same side and any one of no-fistula vein were selected as vein return. Routine puncture was used In control group, artery exit was selected closed to the side of fistula entrance. And punctured toward centripetal. Vein entrance selected in 5 cm above artery terminus. Successful rate of puncture, volume of bleeding, rate of internal fistula obstruction and occurrence of subcutaneous hematoma were compared between the two groups.Results The success rate of once puncture in experimental group were 95.7%, it’s remarkably higher than that of control group (80.3%). The occurrence rate of subcutaneous hematoma in artery end in experimental group 4.29%,which is remarkably lower than that of control group(12.12%)( P <0.01). There is no significant difference in successful rate of once puncture and rate of subcutaneous hematoma in vein end ( P >0.05). Rate of internal fistula obstruction in experimental group is 3.57%, which is significantly lower than of control group (25.93%)( P <0.05). The volume of bleeding during dialysis reached 200ml/min among 82.82% in experimental group, 77.27% in control group, there is no significant difference( P <0 05).Conclusions For patients with dialysis,during the early period of arteriovenous fistula,it’s suitable to select internal fistula elbow vein or Gruiyao vein as artery exit for centripetal puncture.
出处
《护士进修杂志》
北大核心
2004年第5期408-409,共2页
Journal of Nurses Training
