动静脉内瘘穿刺间距选择与再循环发生的护理问题

Nursing problems in the occurrence of recirculation in relation to puncture interval on internal arteriovenous fistula

目的探讨不同的内瘘穿刺间距与再循环及通路流量的关系。方法对第二军医大学长海医院肾内科45例维持性血液透析患者的血管通路分别采用TRANSONICHDO2血液透析监护仪测得实际通路内血流量(Qa),并分为3组:Qa>1000ml/min(13例);Qa600～1000ml/min(20例);Qa<600ml/min(12例),选择不同的穿刺间距(4、6、8、10cm),采用尿素法(UT)和TRANS2种方法进行再循环率测定。结果UT与STRANS的测定结果,采用非参数方法进行统计,Spearman相关系数rs=0.934,P<0.01,结果显示2种测定方法有很好的相关性;当Qa>600ml/min时,在穿刺间距≥4cm时RTRANS(%)=0,RUT(%)=(2.91±0.93),均为阴性结果;当Qa<600ml/min时,RTRANS(%)和针距呈直线负相关,r=-0.956,P<0.01;RUT(%)和针距亦呈直线负相关,r=-0.996,P<0.01;结论在Qa>600ml/min时,大于4cm穿刺间距不会引起R;但在Qa<600ml/min,R随间距的缩短而增大,只有当间距>10cm时无通路内再循环;认为每月进行通路流量检测十分必要,除能指导穿刺间距的选择,利于内瘘保护外,又能及时发现血管功能障碍,提前给予临床干预。

Objective To evaluate the correlation of puncture interval on internal fistula to recirculation and access flow rate. Methods We measured actual access flow rate （Qa） in 45 maintenance hemodialysis patients by using TRANSONIC HD02 haemodialysis monitoring apparatus and then assigned the patients into 3 groups： Qa 〉 1000ml/min （13 cases）, Qa 600- 1000 ml/min （20 cases）, and Qa 〈600ml/min （12 cases）. We adopted 4 different puncture intervals （4, 6, 8, 10cm） and determined the recycling rate by using urea test and TRANS methods. Results Results from urea test and TRANS correlated each other significantly, with Spearman correlation coefficiency rs = 0. 934 and P〈0.01 when non-parameter statistical method was used. When Qa was 〉600 ml/min and puncture interval was 〉 4cm, TRANS rate was 0% and urea test rate was 2.91±0.93%, indicating the negative result. When Qa was 〈600 ml/min, TRANS rate （%） inversely correlated with puncture interval （r = -0.956, P 〈 0.01）, and urea test rate （%） also inversely correlated with puncture interval （r=-0.996, P 〈 0.01）. Conclusion When Qa was 〉600ml/min and puncture interval greater than 4 cm, recirculation would not occur. However, when Qa was 〈600ml/min, recirculation rate increased with the decrease of puncture interval. No recirculation happened in the internal fistula if puncture interval was 〉 10 cm. Monthly measurement of access flow rate is essential for the determination of puncture interval and protection of the fistula. The monthly measurement is also necessary for the prompt disclosure and intervention of fistula dysfunction.