透析用留置针在自体动静脉内瘘扣眼穿刺建立隧道中应用

Application of indwelling needle for AVF buttonhole puncture to establish tunnel for dialysis

目的探讨透析用留置针在自体动静脉内瘘血管建立扣眼隧道中应用价值。方法选取陕西省核工业二一五医院血液透析中心长期血液透析患者67例,其中32例自体动静脉内瘘患者,使用透析用留置针穿刺建立内瘘血管扣眼隧道,作为观察组;35例自体动静脉内瘘患者采用传统锐针穿刺方法建立内瘘扣眼隧道,作为对照组;比较2组患者扣眼隧道的成功时间、成功率、钝针进针一次成功率、后期局部狭窄率等指标。结果与对照组相比,观察组建立内瘘扣眼隧道,其成功时间短[(8.54±1.28)比(12.65±2.38)天,t=0.650,P=0.001],成功率高(χ^2=23.251,P<0.001);扣眼隧道成功后行钝针进针,观察组的一次成功率高(χ^2=21.201,P<0.001),后期局部狭窄率低(χ^2=21.201,P<0.001),差异有统计学意义。结论透析用留置针建立内瘘血管扣眼隧道,成功时间短,成功率高,操作简单,并发症少,是建立扣眼隧道的良好方法,值得临床推崇。

Objective To explore the application value of indwelling needle for dialysis in the establishment of buttonhole tunnel for autologous arteriovenous fistula(AVF). Methods A total of 67 patients on maintenance hemodialysis(MHD) in the Hemodialysis Center of Shanxi Nuclear Industry 215 Hospital were selected. Thirty-two of the patients with AVFs to establish the buttonhole tunnel of internal fistula using puncture and indwelling needle were assigned in observation group;35 of the patients with AVFs used traditional sharp needle puncture method to establish internal fistula buttonhole tunnel were assigned in control group.Success time, success rate, one-time success rate of blunt needle insertion, and late local stenosis rate were compared between the two groups. Result Compared to control group, observation group had a short success time(8.54±1.28 vs. 12.65±2.38 days, t=0.65, P=0.001) and a high success rate to establish the internal fistula buttonhole tunnel(84.38% vs. 71.43%, χ^2=23.251, P<0.001). Compared to control group, observation group had a higher success rate of blunt needle insertion after success of the buttonhole tunnel(100% vs.85.7%, χ^2=21.201, P<0.001) and a lower rate of local stenosis in the later period(100% vs. 85.7%,χ^2=21.201,P<0.001). Conclusions The use of indwelling needles for dialysis to establish an internal fistula vascular buttonhole tunnel is a better method to establish a buttonhole tunnel, with shorter success time, higher success rate, simple operation, and fewer complications.