不同穿刺方法对血液透析动静脉内瘘患者疗效及并发症的比较研究

Comparative study on the curative efficacy and complications of different puncture methods in hemodialysis patients with internal arteriovenous fistula

目的:比较分析不同穿刺方法对血液透析动静脉内瘘患者的疗效及并发症。方法:选取医院收治的120例血液透析患者,采取随机数表法将其分为对照组和观察组,每组60例。对照组给予单次操作常规穿刺方法,观察组给予双次穿刺时压迫穿刺点远心端内瘘血管的穿刺方法,对比两组不同穿刺时间点内瘘血管内膜壁厚度、一次性穿刺成功率、血流量充分率、出血阳性率以及并发症发生率。结果:两组穿刺10次和50次后分别与穿刺前相比内瘘血管内膜壁厚度增加,穿刺50次后与穿刺10次后相比内瘘血管内膜壁厚度增加,观察组穿刺50次后与对照组穿刺50次后相比内瘘血管内膜壁厚度较薄,组间差异具有统计学意义(t=4.936,P<0.05);观察组与对照组相比,一次性穿刺成功率及血流量充分率较高,出血阳性率较低,组间差异具有统计学意义(χ^(2)=5.551,χ^(2)=5.175,χ^(2)=5.551;P<0.05);观察组与对照组相比穿刺相关并发症发生率较低,组间差异具有统计学意义(χ^(2)=3.927,P<0.05)。结论:行动静脉内瘘穿刺时压迫穿刺点远端内瘘血管的操作能够获得更高的穿刺成功率及血流量充分率,对内瘘血管内膜壁厚度影响较小,并发症发生率较低,且安全性更高,穿刺效果更加理想。

Objective:To explore and analyze the curative efficacy and complications of different puncture methods in hemodialysis patients with internal arteriovenous fistula.Methods:120 hemodialysis patients admitted to hospital were selected,and they were divided into control group and observation group according to random number table method,with 60 cases in each group.Control group underwent conventional puncture with single operation,and observation group compressed blood vessels with internal fistula at the terminal far away heart from puncture site when underwent puncture with double puncture.The thickness of inner membrane of blood vessel with internal fistula,the success rate of one-time puncture,sufficient rate of blood flow volume,positive rate of bleeding and incidence rate of complication at different time point of puncture between two groups were compared.Results:Compared with the thicknesses of inner membrane of blood vessel with internal fistula pre puncture,those of two groups at the 10th times and the 50th times post puncture were added,and those of two groups at the 50th times post puncture were thicker than those of two groups at the 10th times post puncture.And those at the 50th post puncture of observation group was significantly thinner than these at the 50th post puncture of control group(t=4.936,P<0.05).Compared with control group,the success rate of one-time puncture and sufficient rate of blood flow volume of observation group were higher,while the positive rate of bleeding of observation group was lower,and there were statistically significant difference in the three indicators between the two groups(χ^(2)=5.551,χ^(2)=5.175,χ^(2)=5.551,P<0.05).The incidence rate of relevant complication of puncture of observation group was significantly lower than that of control group(χ^(2)=3.927,P<0.05).Conclusion:The operation of pressing the distal internal fistula vessels from the puncture point during the operation of the puncture of internal arteriovenous fistula can achieve higher success rate of puncture and sufficient rate of blood flow volume.And its influence on the thickness of the wall of inner membrane of the blood vessels with internal fistula is less,and the incidence of complications is lower,and the safety is higher and the puncture effect is more ideal.