两种穿刺方法对动静脉内瘘并发症和患者疼痛的影响

Comparison of impact of two puncture techniques on complications of arteriovenous fistula and puncture-related pain

目的探讨两种穿刺方法对维持性血液透析患者内瘘并发症发生率和疼痛的影响。方法选择维持性血液透析患者78例,将其中的58例随机分为观察组和对照组各29例。观察组采用顺血流方向针尖斜面向下穿刺方法,对照组采用顺血流方向针尖斜面向上穿刺方法,比较两组血管瘤、血栓、内瘘狭窄发生率。将剩余的20例患者实施自身对照研究,分别采用顺血流方向针尖斜面向下和顺血流方向针尖斜面向上穿刺各20次,采用数字疼痛强度量表记录患者疼痛感受。结果观察组内瘘狭窄发生率显著低于对照组(P<0.05);顺血流方向针尖斜面向下穿刺疼痛程度显著低于顺血流方向针尖斜面向上穿刺(P<0.01);两种穿刺方式的再循环率均为零,对患者透析质量无影响。结论对维持性血液透析患者采用顺血流方向针尖斜面向下穿刺动静脉内瘘,可有效保护动静脉内瘘,减少并发症发生,缓解穿刺时疼痛,不影响透析质量。

Objective To explore the impact of two puncture techniques on complications of arteriovenous fistula and puncture-related pain in maintenance hemodialysis patients. Methods Fifty eight of 78 maintenance hemodialysis patients were randomized into two groups of 29 receiving antegrade puncture technique either with needle bevel upward （the control group） or downward （the observation group）. The occurrence rates of complications （aneurysm formation, thrombosis, and stenosis） were compared between the two groups. The other 20 patients were punctured with both techniques to assess puncture-related pain severity using a numerical rating scale （NRS）. Results The occurrence of stenosis in the observation group was significantly lower than that in the control group （P〈0. 05）. Patients experienced less pain severity when they punctured with needle bevel downward （P〈0. 01）. There was no recirculation to affect hemodialysis adequacy in both groups. Conclusion Antegrade puncture technique with needle bevel downward could protect arteriovenous fistula, reduce complications and puncture-related pain severity, and ensure dialysis quality.