内瘘使用初期不同拔针时间对血液透析内瘘早期并发症影响的研究

Withdrawal time of the punctured needles after blood access on early complications of the freshly used arteriovenous fistulas

目的探讨不同时间点拔针对内瘘初期使用者穿刺点止血时间、渗血率、血肿率、及内瘘并发症的影响,为延长动静脉内瘘使用时间提供依据。方法对40例内瘘使用初期的维持性血液透析患者前10次穿刺后下机压迫止血进行干预研究,采用群组自身对照法将400次压迫止血分别在2个时间点进行:一种是下机后常规立即拔针;另一种是延时拔针法,拔针时间为下机后10min。对2个时间点拔针动静脉内瘘的止血按压时间及内瘘并发症的发生率进行比较。结果 1延时拔针法在止血按压时间(7.16±2.08)min、穿刺点出血量(0.98±1.03)ml方面优于常规立即拔针法(13.68±3.21)min、(4.15±1.55)ml,差异有统计学意义(止血按压时间t=-10.765,P<0.001;穿刺点出血量t=-10.83,P<0.001)。2延时拔针法渗血、皮下血肿、肢体麻木肿胀的发生率(38.00%,0.00%,6.00%)低于常规拔针法(51.50%,4.00%,22.50%),差异均有统计学意义(渗血率χ2=7.371,P=0.009;皮下血肿率χ2=8.163,P=0.007;肢体麻木肿胀率χ2=25.823,P=0.001)。结论透析结束后保留内瘘穿刺针10min再进行压迫止血,可明显降低内瘘使用初期患者内瘘并发症的发生率,延长内瘘的使用寿命。

Objective To provide the basis for longer use of arteriovenous fistulas, we explored the with- drawal time of the punctured needles after hemodialysis on hemostasis time, exudative bleeding rate and he- matoma formation rate at the punctured area, and internal fistula complications in maintenance hemodialysis （MHD） patients with freshly used internal fistulas. Methods A self-control method was carried out for 40 new MHD patients with freshly used internal fistulas. The punctured needle was withdrawn immediately or delayed for 10 min, and the punctured site was pressed for about 10 min after withdrawal. The first 10 punc- tures with a total of 400 punctures were analyzed. The pressed duration on punctured site and the internal fistu- la complications were analyzed between immediate withdrawal of the needles after hemodialysis and delayed withdrawal of the needles for 10 min. Results ①Press duration for hemostasis was （7.16±2.08）min and （13.68±3.21） rain （t =-10.765, P〈0.001） for delayed and immediate withdrawal of the needles, respectively. Local bleeding volume was 0.98±1.03 ml and （4.15±1.55） ml （t=-10.83, P〈0.001） for delayed and immediate withdrawal of the needles, respectively. ②The prevalence of exudative bleeding, hematoma, and numbness/ swelling was 38.00%, 0.00% and 6.00%, respectively for delayed withdrawal of the needles, and was 51.50%, 4.00% and 22.50%, respectively for immediate withdrawal of the needles （x^2=7.371, 8.163, 25.823, respectively; P〈0.01）. Conclusion The needle punctured into internal fistula should be remained in situ for 10 min af- ter hemodialysis, and the punctured site was pressed after withdrawal. This method can significantly reduce the incidence of early fistula complications and extend the useful period of the fistulas.