自体动静脉内瘘扣眼穿刺感染的分析及预防

Analysis and prevention of infections for buttonhole cannulation of autogenous arterio-venous fistula

目的探讨自体动静脉内瘘扣眼穿刺感染的原因及预防对策,为临床治疗提供参考依据。方法回顾性分析2011年4月-2016年10月医院血透中556例自体动静脉内瘘发生感染的情况,按穿刺方法分为扣眼穿刺法组75例,其他穿刺法(区域和绳梯式)组481例,比较两组患者感染率。结果其他穿刺法组无一例感染,扣眼穿刺并发感染10例(13.33%),症状表现为扣眼穿刺局部出现红、肿、热、痛、痒,针眼处渗液或脓性分泌物,其中1例继发败血症,根据感染的特点给予针对性的治疗和护理,未出现一例功能丧失。结论扣眼穿刺并发感染主要原因是内瘘穿刺针过敏,患者卫生习惯不良、免疫功能低下和反复钝针试穿,因此,预防扣眼感染要从以上几方面着手。

OBJECTIVE To investigate the causes and preventive measures of the infections for buttonhole cannula- tion of autogenous arterio-venous fistula, so as to provide references for clinical treatment. METHODS The clinical data of 566 infected patients with autogenous arterio-venous fistula in the hospital from Apt 2011 to Oct 2016 were retrospectively analyzed. According to the puncture method, the patients were divided into 75 cases using button- hole technique and 481 cases using other techniques （rope-ladder and area technique）, and the infection rates be- tween the two groups were compared. RESULTS No infection was found using other techniques （rope-ladder and area technique）, while 10 （13.33%） cases occurred infections by the buttonhole technique with the symptoms of redness, swelling, heat, pain, itching, the needle eye with exudation and purulent secretion, even one case with septicemia. No one suffered vascular access loss after treatment and care according to the characteristics of the in- fection. CONCLUSION The main reasons for the infections of patients using buttonhole technique are as follows： allergy to the needle, adverse health habits, immunocompromise and repeated puncture, so reasonable measure- ments are essential to prevent the infection according to these reasons.