疑难自体动静脉内瘘穿刺技巧探讨

Puncture techniques for establishing the complicated autogenous arteriovenous fistula

目的探讨提高疑难自体动静脉内瘘穿刺技术,以期提高穿刺成功率。方法选取2017年10月—2018年10月上海市东方肝胆外科医院、上海市浦南医院、上海中医药大学附属第七人民医院血液净化中心收治的104例疑难自体动静脉内瘘行维持性血液透析患者作为研究对象,各中心成立血管通路小组,评估穿刺条件,分析穿刺技巧,实施个体化穿刺。结果104例疑难自体动静脉内瘘穿刺患者中有86例患者成功穿刺且未发生相关并发症。5例患者发生内瘘栓塞,6例患者发生内瘘堵塞,5例发生瘘口狭窄,均在针对性干预后恢复内瘘功能。结论通过提高穿刺技巧,实施个体化穿刺,可有效提高疑难动静脉内瘘的穿刺成功率。

Objective To discuss the puncture techniques for establishing the complicated autogenous arteriovenous fistula(AVF).Methods Totally 104 patients with difficulty in establishing AVF were included as research subjects.A group of nurses for establishing vascular access were set up.Nurses had evaluated the vascular conditions and analyzed the puncture techniques before implementing individualized puncture plan.results Of 104 cases of complicated AVF,86 cases were established successfully without any complications.AVF-related complications mainly included thrombosis in 5 cases,blockage in 6 cases and stenosis in 5 cases,and the function of affect AVFs were restored after implementation of tar geted inter ventions.Conclusion The individualized puncture plan with modified techniques is potentially effective to improve the successful rate of puncture for establishing the complicated AVF.