动静脉内瘘及静脉2种固定方法临床应用的比较

Clinical comparison f internal arteriovenous fistula and vein with two different fixations

目的探讨血液透析过程中选择合适的动静脉内瘘及静脉穿刺针固定方法,以减少血液透析过程中动静脉内瘘及静脉穿刺针眼渗血、滑针、血肿等并发症的发生。方法选择在血液净化中心行维持性血液透析,伴有动脉压高、糖尿病,透析过程中易发生渗血、滑针、血肿并发症的老年患者16例,将患者进行自身对照,先后采用常规胶布固定法和常规胶布加弹力绷带固定法。每人每种方法各观察3个月624次,共1248次由专职透析护士按标准化操作。比较2组透析过程渗血、滑针、血肿的发生率。结果常规固定法并发症发生率为7.21%,常规加绷带固定法渗血、滑针、血肿并发症发生率为1.44%,2组比较差异有统计学意义(P<0.01)。结论常规加绷带固定法能有效预防透析过程动静脉内瘘和静脉渗血、滑针、血肿等并发症,减少血管损伤,操作简便,能显著减少护理工作量和医疗成本,提高患者的满意度。

Objective To explore the selection of proper internal arteriovenous fistula and vein and method for fixation of puncture needle during the hemodialysis process in order to reduce the complications such as staxia of puncture position, sliding needle and hematoma. Method 16 el- derly patients with maintenance hemodialysis, arterial hypertension, diabetes and high risk of com- plications during dialysis process were treated with conventional adhesive plaster firstly and conven- tional adhesive plaster combined with elastic bandage secondly. Every patient underwent each method for 624 times in 3 months, and a total of 1248 times standard manipulation was operated by specified dialysis nurses. Incidences of staxis, sliding needle and hematoma were compared between two groups. Results Incidence of complication with conventional fixation was 7.21%, while the incidence of complication with conventional fixation and elastic bandage fixation was 1.44 %, there was statistical difference between two groups（P 〈 0.01）. Conclusion Conventional fixation com- bined with elastic bandage can effectively prevent the occurrence of complications such as staxis, sliding needle and hematoma during the hemodialysis process as well as reduce the injury of blood vessel. It can not only reduce nursing workload and medical costs, but also improve the patients＇sat- isfactions.