自体动静脉内瘘阻塞原因分析及护理对策

Analysis of native arteriovenous fistula obstruction reasons and caring strategy

目的 探讨血液透析患者内瘘阻塞的可能原因和预防发生阻塞的护理对策。方法 183例透析患者中有 4 1例发生血管内瘘阻塞。对比内瘘发生阻塞前后的血红蛋白 (HB)、血小板 (PLT)、白蛋白 (ALB)、甘油三酯 (TG)、胆固醇 (CHO)、红细胞压积 (HCT)的变化。并用logistic分析方法 ,将 4 1例发生内瘘阻塞与14 2例内瘘未发生阻塞的患者的年龄、性别、HB、PLT、ALB、TG、CHO、HCT以及内瘘使用年限用进行多因素回归分析。结果 分析结果显示内瘘阻塞多发生在使用的早期 ,其阻塞发生率为 2 2 .4 % (41/ 183)。配对t检验单因素统计分析和logistic多因素回归方法分析 ,结果显示透析后血红蛋白 (HB)、血小板 (PLT)的升高和白蛋白 (ALB)的降低具有统计学的相关性 (P <0 .0 0 0 1)。结论 为避免患者内瘘阻塞 ,特别是在内瘘成熟早期行血液透析时应注意改善患者的营养状态 ,提高血浆白蛋白 ;适量使用促红细胞生成素 ,缓慢地提高血红蛋白 ,避免上升过快 ;恰当地应用抗凝治疗 ;采取阶梯式穿刺法 ,透析后采取点状压迫 ,防止力量过大 ,加压时间勿过长和对患者及家属进行保护内瘘的宣教都是预防内瘘发生阻塞的重要措施。

Objective To investigate the fistula obstruction reasons and the treatments to prevent the obstruction. Methods Fourty-one patients of 183 maintenance hemodialysis patients suffered from vascular fistula obstruction. Hemoglobin(Hb), platelet(plt), albumin(Alb),triglyceride(TG),cholesterol(CHO) and haematocrit values(HCT) were compared between before obstruction and after obstruction. Age,sex,Hb,Plt,ALB,TG,CHO,HCT and the duration of fistula usage were compared between the 41 obstruction patients and 142 non-obstruction patients with logistic method. Results Fistula obstruction occurred at the early stage of the maturation, the incidence of obstruction was 22.4%(41/183).There were significant difference between the two group of the increase of Hb,Plt and the decrease of ALB(P<0.0001). Conclusion To prevent the vascular obstruction especially at the early stage of the fistula maturation, improve the nutrition status such as increase plasma albumin, increase Hb slowly with EPO and anti-coagulate therapy properly are effective. To puncture by step, press with a proper power at one point after dialysis and educate the patients and their relatives on how to protect fistula are also very important.