不同穿刺方向对血液透析患者早期动静脉内瘘功能的影响

Effect of different puncture directions on early arteriovenous fistula function in hemodialysis patients

目的探讨不同穿刺方向对血液透析患者早期动静脉内瘘功能的影响。方法将52例新成熟自体动静脉内瘘患者分为两组,各26例。顺穿组在早期穿刺时进行向心方向穿刺;反穿组在早期穿刺时进行离心方向穿刺,两组另选一个静脉回路建立体外循环。比较两组的穿刺效果。结果两组BUN清除率与Scr清除率无显著差异(P>0.05);顺穿组的一次穿刺成功率、穿刺点渗血、皮下血肿发生率均优于反穿组(P<0.01);顺穿组动脉瘤及内瘘阻塞发生率均低于反穿组,内瘘狭窄发生率高于反穿组(P<0.05)。结论动脉端向心方向穿刺能减少内瘘并发症的发生并能保证透析的效率。

Objective To study the effect of different puncture directions on early arteriovenous fistulas function in hemodialysis patients. Methods A total of 52 patients with new mature autologous arteriovenous fistula were divided into two groups, with 26 cases in each group. The forward puncture group was punctured in the centripetal direction in the early stages. The backward puncture group was punctured in the centrifugal direction in the early stages. Two groups choosed another venous circuit to establish extracorporeal circulation. The puncture effects in both groups were compared. Results There were no significant differences in clearance rates of BUN and Scr in both groups （P〉0.05）. The success rate of puncture at the first time, incidences of puncture point exudation of blood and subcutaneous hematoma in the forward puncture group were better than those in the backward puncture group （P〈0.01）. The incidences of aneurysm and fistula obstruction in the forward puncture group were lower than those in the backward puncture group, the incidence of fistula stenosis was higher than that in the backward puncture group （P〈0.05）. Conclusion Puncture in the centripetal direction of the arterial end can reduce the fistula complications and ensure the efficiency of dialysis.