血液透析紧急血管通路的选择及并发症的护理

Choice of vascular access for acute hemodialysis and the nursing interventions in complications

为探讨急性血液透析（血透）时建立血管通路与适应证和并发症发生的关系。通过对７２例急性血透时紧急血管通路的选择、并发症和护理对策的探讨，发现气胸、动脉损伤与血肿、菌血症、导管阻塞、血流量低为其主要并发症。提示：（１）并发症的发生率与血透通路的选择有一定的相关性：动静脉直接穿刺，易引起血肿、血流量低；锁骨下静脉导管容易引起气胸；股静脉导管容易引起动脉损伤、血肿、菌血症及导管阻塞。（２）适应证与血管通路的选择性有一定的关系：心肺功能不全宜选择股静脉导管，腹部疾患宜选择锁骨下静脉导管，急性药物中毒首选动静脉直接穿刺。

Discussed the relation between the choices of vascular access for acute hemodialysis and their complications as well as nursing interventions in 72 cases. It was found that pneumothorax, of artery injury, haematoma, bacteriemia, tubular obstruction and low blood flow were the main complications. It was suggested that the occurence of complication was related to the choice of vascular access. (1) Arteriial or venous puncture was prone to cause haematoma and low blood flow while subclavian vein cannula tended to cause pnumothorax, and femoral vein cannula tended to cause artery injury, haematoma and tubular obstruction. (2) Relations between the indication and the choice of vascular access were that for patients with cardiac and pneumal insufficiency one should use femoral vein cannula, for patients with abdominal disease one should use subclavian vein cannula and for acute drug poisoning one should use arterialorvenous puncture. The results showed that rational choices of vascular access for acute hemodialysis and effective nursing reduced the complications.