疑难内瘘患者穿刺方法的改良及应用

Application of zero-pressure modified puncture technique in hemodialysis patients with difficult arteriovenous fistula

目的探讨零压力改良穿刺法在疑难内瘘患者穿刺中的应用效果。方法选取2014年1月-2016年4月某三级甲等医院血液透析中心126例疑难内瘘患者,随机分成试验组(64例)和对照组(62例),试验组采用零压力改良穿刺法,对照组采用常规穿刺方法,比较两组的一次性穿刺成功率,随访患者36个月内瘘相关并发症的发生情况,进行Kaplan-Meier生存曲线分析。结果试验组的一次性穿刺成功率高于对照组(P<0.01);试验组内瘘相关并发症发生率低于对照组(P<0.01);试验组并发症发生时间为(21.42±11.37)个月,晚于对照组(14.71±9.18)个月,差异有统计学意义(P<0.01)。结论零压力改良穿刺法能提高疑难内瘘一次性穿刺成功率,减少疑难内瘘相关并发症,推迟动静脉内瘘相关并发症发生时间。

Objective To explore the effects of zero-pressure modified puncture technique in hemodialysis patients with difficult arteriovenous fistula(AVF).Methods The hemodialysis patients with difficult AVF at a hemodia-lysis center in a tertiary hospital from January 2014 to April 2016 were recruited and randomly allocated into an experimental group(n=64)and a control group(n=62).The patients in the experimental group were punctured with the zero-pressure modified puncture technique,while the patients in the control group were punctured with routine method.The first-attempt success rate was compared between 2 groups.All patients were followed up for 36 months and relevant complications were recorded.Kaplan-Meier survival curve and log-rank test were conducted.Results The first-attempt success rate in the experimental group was significantly higher than that in the control group(P<0.01);the incidence of the complications of AVF in the experimental group was significantly lower than that in the control group(P<0.01);the duration without complication of AVF in the experimental group as(21.42±11.37)months was significantly longer than that in the control group as(14.71±9.18)months(P<0.01).Conclusion For difficult AVF,zero-pressure modified puncture technique can increase first-attempt success rate,decrease complications of difficult AVF and significantly prolong the duration without complications.