彩色多普勒超声引导较深动静脉新内瘘穿刺的临床应用

The clinical application of color Doppler ultrasound in guiding the puncture of new internal fistula in deep arteriovenous

目的探讨彩色多普勒超声引导在血液透析患者较深的动静脉新内瘘穿刺中临床应用价值。方法选择武汉市第一医院血液透析室动静脉内瘘深度≥5 mm的30例新内瘘患者,采用IBM SPSS Statistics 22.0软件随机数字生成器法分为观察组和对照组各15例患者。观察组采用彩色多普勒超声引导穿刺共855次,对照组采用常规有经验的护士进行盲穿法共849次。通过对比观察组和对照组2组较深的动静脉内瘘新瘘患者在6个月内的一次性穿刺成功率,内瘘穿刺失误所致皮下血肿、渗血、疼痛、中断或延期治疗、误伤动脉等不良事件的发生率,以及患者对穿刺及透析效果的满意度评分,来观察彩色多普勒超声引导在较深的动静脉新内瘘穿刺中进行临床应用的优势。结果观察组患者内瘘穿刺一次性穿刺成功率为98.95%(846/855),显著高于对照组的81.27%(690/849),差异有统计学意义(χ2=149.753,P<0.01);观察组内瘘穿刺失误导致皮下血肿、渗血、疼痛、中断或延期治疗的发生率分别为0.58%(5/855)、0.94%(8/855)、0.47%(4/855)、0,对照组分别为17.20%(146/849)、2.47%(21/849)、2.12%(18/849)、1.06%(9/849),2组比较差异有统计学意义(χ2=145.557、6.022、7.875、Fisher精确检验,P<0.01或0.05);临床上误伤动脉的发生率极低,观察组为0,对照组为0.12%(1/849),差异无统计学意义(P>0.05);2组患者因内瘘穿刺失误所致不良事件总发生率分别为1.99%(17/855)和22.97%(195/849),差异有统计学意义(χ2=172.126,P<0.01);观察组患者满意度平均秩为1261.25,高于对照组的440.86,差异有统计学意义(Z=-38.107,P<0.01)。结论彩色多普勒超声引导在血液透析患者较深的新动静脉内瘘穿刺中具有重要的临床应用价值,能显著提高新内瘘的一次性穿刺的成功率,减少因穿刺失败导致不良事件发生,减轻患者痛苦,值得临床推广。

Objective To investigate the clinical value of color Doppler ultrasound guidance in the puncture of new internal fistula in deep arteriovenous of hemodialysis patients.Methods Selected thirty patients with arteriovenous fistula not less than 5 mm deep in the Department of Hemodialysis Room of Wuhan First Hospital,and they were divided into observation group and control group by the method of random number generator in IBM SPSS Statistics 22.0 software,with 15 patients in each group.The control group was treated with conventional blind puncture by experienced nurses(849 times),while the observation group was treated with color Doppler ultrasound guided puncture(855 times).By comparing two groups of deep arteriovenous fistula in new fistula patients within 6 months of the one-time success rate of puncture,the incidence of adverse events such as subcutaneous hematoma,bleeding,pain,interruption or postponement of treatment,and accidental injury to arteries caused by puncture errors of internal fistula,and the patient′s satisfaction with the puncture and dialysis results was evaluated to observe the advantage of color Doppler ultrasound guidance in clinical application of deep arteriovenous new fistula puncture.Results The success rate of one-time puncture for internal fistula puncture in observation group was 98.95%(846/855),which was significantly higher than that in control group 81.27%(690/849),and the difference was statistically significant(χ2=149.753,P<0.01).The incidence of subcutaneous hematoma,bleeding,pain,interruption or delayed treatment in observation group respectively was 0.58%(5/855),0.94%(8/855),0.47%(4/855)and 0,however,in control group was 17.20%(146/849),2.47%(21/849),2.12%(18/849)and 1.06%(9/849),respectively.There were significant differences between the two groups(χ2=145.557,6.022,7.875,Fisher′s exact test,P<0.01 or 0.05).The incidence of arterial injury was extremely low in clinical practice,with 0 in observation group and 0.12%(1/849)in control group,and the difference was not statistically significant(P>0.05).The total incidence of adverse events caused by internal fistula puncture errors in the two groups was 1.99%(17/855)and 22.97%(195/849),respectively,and the difference was statistically significant(χ2=172.126,P<0.01).The average rank of satisfaction in observation group was 1261.25,which was higher than control group 440.86,and the difference was statistically significant(Z=-38.107,P<0.01).Conclusions Color Doppler ultrasound guidance in the puncture of new internal fistula in deep arteriovenous of hemodialysis patients has important clinical application value.It can significantly improve the success rate of one-time new internal fistula puncture,reduce the occurrence of adverse events due to puncture failure,and reduce patient′s pain,which is worthy of clinical promotion.