扣眼穿刺技术的合理实施及管理

目的 探讨扣眼穿刺法在血透病人内瘘穿刺中的有效实施方法.方法 方便性选取2014年11月至2016年3月在我院透析中心采用自体动静脉内瘘行扣眼穿刺进行维持性血液透析的患者115例,均采用扣眼穿刺方法,其中前期30例和后期30例共60例为实验组,在隧道形成前采用“三定三同法”进行管理,即定透析区域（A区）、定穿刺针型号（NIPORO17G） 、定穿刺护士、同一穿刺点、同一穿刺角度、同一穿刺深度进行锐针穿刺,穿刺约10次左右,依据护士的直观感觉,即当穿刺时感觉内瘘针无阻力滑进血管时,即形成了皮下固定隧道——扣眼,在扣眼形成后,转入其他普通区域,由经培训后的护士使用钝针穿刺.回顾性选取中期55例为对照组,实行“四同方法”进行管理,即同一摆放体位、同一穿刺点、同一穿刺角度、同一穿刺深度进行锐针穿刺,穿刺10次左右改为钝针穿刺.观察三个月比较两组患者的穿刺成功率、感染率、隧道形成、穿刺方法变异及病人疼痛评分的差异.结果 实验组患者不论在锐针或钝针穿刺时,一次性穿刺成功率及病人疼痛评分方面明显优于对照组,有统计学意义（p 〈0.05）,改为钝针后,隧道形成和穿刺方法变异方面也优于对照组,有统计学意义（p〈0.05）.两组病人内瘘感染率比较差异无统计学意义（p〉0.05）.结论“三定三同法”对扣眼穿刺的实施明显优于“四同方法”.

objective to explore the buttonhole puncture approach of effective implementation of internal fistula in hemodialysis patients puncture approach. Methods convenience in November 2014 to March 2016 in our dialysis center button line with autogenous arteriovenous internal fistula puncture in maintenance hemodialysis patients 115 cases, adopt buttonhole puncture method, one of 30 cases of early and late 60 cases of experimental group, 30 cases were formed in the tunnel before using “armed meet approach”, namely to determine dialysis area （area A）, needle type （NIPORO17G）, or puncture nurses, the same the puncture point, puncture Angle, the same puncture depth of sharp needle puncture, puncture for about 10 times, according to the nurse’s intuitive sense, namely when feeling inside fistula needle puncture resistance to slip into the blood vessels, which formed the subcutaneous tunnel - fixed buttonhole, formed in the eye, turn to other common areas, by the nurse in the after training using A blunt needle puncture. Retrospectively from middle of 55 cases as control group, with approachs“on” four management, namely, put in the same position, same the puncture point, the same puncture point, puncture depth in sharp needle puncture, puncture of about 10 times to blunt needle puncture. Observe three months compare two groups of patients with puncture success rate, infection rate variation, tunnel formation, puncture and patients pain score difference. The results of the experimental group patients in both the sharp or blunt needle puncture needle, one-time success rate of puncture and pain score is better than that in control group, patients was statistically significant （p 〈 0.05）, after changed to blunt needle, the tunnel form variation and puncture is better than that in control group, with statistical significance （p 〈 0.05）. Within the two groups of patients with fistula infection rate comparison difference has no statistical significance （p 〉 0.05）. Conclusion “armed meet approach” button on the puncture is superior to the implementation of the “four approachs”.