不同穿刺方法对透析患者动静脉内瘘的影响

Effects of Different Puncturing Methods on Internal Arteriovenous Fistula of Patients with Hemodialysis

目的:探讨不同穿刺方法对血液透析患者动静脉内瘘的影响,为患者选择最佳穿刺方法提供依据。方法:将透析1年以上的124例患者分为治疗组和对照组各62例,分别采用阶梯式或纽扣式穿刺法和常规穿刺方法,观察穿刺时渗血、血肿、内瘘血管内膜壁厚度及内瘘瘤、内瘘狭窄、堵塞等并发症发生情况。结果:治疗组不良事件发生情况均明显少于常规随意点穿刺法,差异具有统计学意义(P<0.05);在穿刺50次后实验组血管内膜壁厚度小于对照组,差异具有统计学意义(P<0.05);穿刺1年后,治疗组患者动脉瘤、内瘘狭窄、堵塞等不良并发症发生情况均明显少于常规随意点穿刺法,差异具有统计学意义(P<0.05)。结论:阶梯式或纽扣式穿刺方法,能够明显减少穿刺渗血、血肿、穿刺失败等不良事件的发生率,减少血管内膜壁的增生,降低内瘘瘤、血管狭窄、血管堵塞等并发症的发生。

Objective： To provide evidence for the patients choosing the optimal puncturing method through discussing the effects of different methods on internal arteriovenous fistula of patients with hemodialysis. Method： All 124 patients on dialysis more than one year were randomized into the treatment group and the control group. Both groups were given with stepped or button-type puncture and routine puncture respectively, the complications of aneurysm, internal fistula constriction and occlusion, adverse reactions of hemorrhage, hematoma and the thickness of internal fistula vascular intimal wall were observed. Result： The incidences of adverse reaction in the treatment group was obviously less than that of the control group, the difference had statistical meaning （P〈0.05）; after punc- turing for 50 times, the thickness of vascular intimal walls in the treatment group was smaller than that of the control group, the difference had statistical meaning （P〈0.05）; after puncturing for one year, the incidences of complications such as aneurysm, internal fistula constriction, occlusion and others, the difference had statistical meaning （P〈0.05）. Conclusion： Stepped or button-type puncture could significantly decrease the incidences of hemorrhage, hematoma and puncture failure, reduce the hyperplasia of vascular intimal wall and the complications： aneurysm, vascular constriction and occlusion.