两种不同的彩色超声引导方式在肥胖患者自体动静脉内瘘穿刺中的应用比较

Comparison of two color ultrasound guided methods for puncture of autogenous arteriovenous fistula in obese patients

目的比较彩色超声探头纵切面显示和横切面显示两种不同方式在肥胖患者自体动静脉内瘘(AVF)引导穿刺中效果差异。方法选择40例血液透析(HD)肥胖患者(AVF穿刺段血管皮脂深度均>5 mm),其中男性17例,女性23例;年龄24~55岁,平均年龄38.15岁;男性肱三头肌皮脂平均厚度为13.74 mm(标准差1.32 mm),女性为18.91 mm(标准差2.13 mm)。随机分为观察组和对照组,各20例。观察组采用彩色多普勒超声探头纵切面显示引导穿刺的方法,对照组采用彩色多普勒超声探头横切面显示引导穿刺的方法。对比两组患者在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、疼痛等不良事件的发生率,以及患者的满意度评分;观察哪一种显示方式在较深AVF引导穿刺中更具有优势。结果观察组患者内瘘血管一次性穿刺成功率为99.20%,高于对照组(98.03%),差异有统计学意义(χ^(2)=5.599,P<0.05);观察组内瘘穿刺失误导致皮下血肿、渗血、疼痛发生率分别为0.80%、0.54%、0.45%,低于对照组(1.80%、1.53%、1.44%),差异有统计学意义(χ^(2)=4.287、5.376、5.876,P<0.05);两组患者因内瘘穿刺失误所致不良事件总发生率分别为1.79%、4.76%,差异有显著统计学意义(χ^(2)=15.606,P<0.001);观察组患者满意度平均秩为1668.54,高于对照组(563.49),差异有显著统计学意义(Z=-46.554,P<0.001)。结论彩色多普勒超声引导在HD肥胖患者较深的AVF穿刺中具有重要的临床应用价值,能显著提高动静脉内瘘的一次性穿刺的成功率,但超声探头纵切面显示的引导方式更具有优越性,值得临床推广。

Objective To compare the effect of longitudinal section display and cross section display of color ultrasound probe for autologous arteriovenous fistula(AVF)guided puncture in obese hemodialysis(HD)patients.Methods A total of 40 HD obese patients(AVF puncture segment blood vessel sebum depth>5 mm)were enrolled,which included 17 male and 23 females,aged 24-55 years old with mean age of 38.15 years old;the mean thickness triceps sebum in male was 13.74 mm(standard deviation 1.32 mm)and in female was 18.91 mm(standard deviation 2.13 mm).All of them were randomly divided into observation group(n=20,guided puncture by color Doppler ultrasound probe longitudinal section display)and control group(n=20,guided puncture by color Doppler ultrasound probe cross-sectional display).The puncture success rate within 6-month,subcutaneous hematoma incidence,blood oozing,pain caused by internal fistula puncture errors,and patient satisfaction score were compared between 2 groups.The advantages of 2 methods in deeper AVF guided puncture were observed.Results The success rate of internal fistula puncture in observation group was 99.20%,which was statistically significantly higher than that in control group(98.03%)(χ^(2)=5.599,P<0.05).The subcutaneous hematoma incidence,blood oozing,and pain caused by internal fistula puncture errors were 0.80%,0.54%and 0.45%,which were statistically significantly lower than those of control group(1.80%,1.53%,1.44%)(χ^(2)=4.287,5.376,5.876,P<0.05).The total incidence of adverse events caused by internal fistula puncture errors in 2 groups was 1.79%and 4.76%,respectively,and the difference was statistically significant(χ^(2)=15.606,P<0.001).The mean rank of patient satisfaction in observation group(1668.54)was statistically significantly higher than that of control group(563.49;Z=-46.554,P<0.001).Conclusion It is demonstrated that color Doppler ultrasound guidance showed important clinical application value in deeper AVF puncture of obese HD patient,which could significantly improve success rate of AVF puncture,the longitudinal section of ultrasound probe is worthy of clinical promotion in view of their more advantages.