一次性钝针扣眼穿刺法在中老年血液透析患者自体动静脉内瘘穿刺中的应用

Application of disposable blind needle buttonhole puncture in autologous arteriovenous fistula puncture of middle-aged and elderly hemodialysis patients

目的观察一次性钝针扣眼穿刺法应用于中老年血液透析患者内瘘穿刺中的效果。方法 80例进行维持性血液透析的中老年患者,使用电脑随机数字表法分为观察组和对照组,每组40例。对照组患者采用普通锐针绳梯法进行内瘘穿刺,观察组患者采用一次性钝针扣眼穿刺法进行内瘘穿刺。比较两组患者基本情况;血管内瘘持续扩张、假性动脉瘤及臂围情况;B超下血管壁血栓形成、血管堵塞手术修复情况;血管内瘘一次穿刺成功率。结果在80例患者中,观察组有1例患者退出,1例因心脏疾病意外死亡;对照组患者有2例因脑血管意外死亡。两组患者性别、年龄、透龄、残余尿素清除指数(KT/V)、总KT/V、血红蛋白(Hb)、血糖(GLU)比较差异无统计学意义(P>0.05)。观察组患者血管内瘘持续扩张、血管假性动脉瘤形成例数少于对照组,臂围扩张增粗程度低于对照组,差异具有统计学意义(P<0.05)。观察组患者B超下血管壁血栓形成、血管堵塞手术修复例数少于对照组,差异具有统计学意义(P<0.05)。观察组患者血管内瘘一次穿刺成功率为98.84%,高于对照组的86.73%,差异具有统计学意义(P<0.05)。结论采用一次性钝针扣眼穿刺法对血液透析中老年患者进行自体动静脉内瘘穿刺,能够减少内瘘假性动脉瘤再扩张的发生,降低内瘘血管堵塞率,提高一次性穿刺成功率,有利于保护患者自体动静脉内瘘,延长使用时间。

Objective To observe the effect of disposable blind needle buttonhole puncture in autologous arteriovenous fistula puncture of middle-aged and elderly hemodialysis patients. Methods A total of 80 middleaged and elderly hemodialysis patients with maintenance hemodialysis were divided into observation group and control group according to computer random number table method, with 40 cases in each group. The control group was punctured by common sharp needle rope ladder method, and the observation group were punctured by disposable blind needle buttonhole puncture method. Comparison were made on basic condition, continuous dilatation of vascular fistula, pseudoaneurysm and brachial circumference, thrombosis of vascular wall under B-mode ultrasonography and surgical repair of vascular occlusion, and successful rate of disposable puncture for endovascular fistula between the two groups. Results Among the 80 patients, 1 patient in the observation group withdrew, 1 patient died of cardiac disease accident. 2 patients in the control group died of cerebrovascular accident. Both groups had no statistically significant difference in gender, age, dialysis time, residual urea clearance index(KT/V), total KT/V, hemoglobin(Hb), blood glucose(GLU)(P>0.05). The observation group had less cases of continuous dilatation of vascular fistula and pseudoaneurysm formation than the control group,and lower arm circumference enlargement than the control group. Their difference was statistically significant(P<0.05). The observation group had less cases of thrombosis of vascular wall under B-mode ultrasonography and surgical repair of vascular occlusion than the control group, and the difference was statistically significant(P<0.05). The observation group had higher successful rate of disposable puncture for endovascular fistula as98.84% than 86.73% in the control group, and the difference was statistically significant(P<0.05). Conclusion Autologous arteriovenous fistula puncture in middle-aged and elderly hemodialysis patients with disposable blind needle buttonhole puncture can reduce the occurrence of dilatation of internal fistula pseudoaneurysm, lower vascular occlusion rate, improve the success rate of disposable puncture, and help protect the patients’ autologous arteriovenous fistula and prolong the application time.