球囊扩张治疗血液透析患者动静脉内瘘狭窄的围术期护理效果评价

Perioperative nursing effect evaluation of percutaneous transluminal angioplasty for hemodialysis patients with arteriovenous fistula stenosis

目的评价球囊扩张治疗血液透析患者动静脉内瘘狭窄的围术期护理效果。方法选择2019年3月至2021年4月在广州市花都区人民医院行动静脉内瘘狭窄经皮腔内血管成形术(PTA)的64例维持性血液透析患者为研究对象,2019年3月至2020年3月行PTA治疗的32例患者作为对照组,2020年4月至2021年4月行PTA治疗的32例患者作为试验组。对照组男21例、女11例,年龄(59.72±13.22)岁;试验组男23例、女9例,年龄(58.41±14.16)岁。对照组患者采用常规护理方法,试验组患者在常规护理基础上采用更全面的围术期护理干预,随访6个月。观察两组患者PTA治疗前后的血管内径、血管自然血流量、穿刺针血流量及临床检验结果,统计两组患者并发症发生率及内瘘狭窄复发率。统计学方法采用独立样本t检验、配对t检验、χ^(2)检验。结果两组患者PTA治疗后的血管内径、血管内自然血流量、穿刺针血流量、血红蛋白、血白蛋白、尿素清除率、血磷均较手术前有改善,而且试验组改善均明显优于对照组,差异均有统计学意义(均P<0.05)。试验组患者透析并发症发生率为12.5%(4/32),明显低于对照组的37.5%(12/32),差异有统计学意义(χ^(2)=5.333,P=0.021);术后随访6个月,试验组患者无内瘘狭窄复发,对照组患者有6例(18.75%)内瘘狭窄复发,差异有统计学意义(P=0.024)。结论对接受PTA治疗动静脉内瘘狭窄的血液透析患者进行围术期的护理干预,临床效果显著,值得推广。

Objective To investigate the perioperative nursing effect of percutaneous transluminal angioplasty(PTA)for hemodialysis patients with arteriovenous fistula(AVF)stenosis.Methods Sixty-four maintenance hemodialysis patients taking PTA for AVF stenosis in Huadu District People's Hospital from March 2019 to October 2021 were selected.The 32 patients treated from March 2019 to March 2020 were set as a control group,and the 32 ones from April 2020 to April 2021 as an experimental group.There were 21 males and 11 females in the control group,and they were(59.72±13.22)years old.There were 23 males and 9 females in the experimental group,and they were(58.41±14.16)years old.The control group were routinely cared;in addition,the experimental group took comprehensive perioperative nursing.Both groups were followed up for 6 months.The internal fistula vessel diameters,internal fistula natural blood flow volumes,puncture needle blood flow volumes,and clinical detection results before and after PTA were observed in both groups.The incidences of complications and the recurrence rates of AVF stenosis in both groups were calculated.The independent-sample t test,paired t test,andχ^(2) test were applied.Results After PTA,the vascular diameter,intravascular natural blood flow volume,puncture needle blood flow volume,hemoglobin(Hb),blood albumin(ALB),urea clearance rate(URR),and blood phosphorus(P)were better than those before PTA,and were significantly better in the experimental group than in the control group,with statistical differences(all P<0.05).The incidence of complications and recurrence rate of AVF stenosis in the experimental group were significantly lower than those in the control group[12.5%(4/32)vs.37.5%(12/32)and 0 vs.18.75%(6/32)],with statistical differences(χ^(2)=5.333,P=0.021 and 0.024).Conclusion Perioperative nursing intervention for hemodialysis patients with AVF stenosis treated by PTA has significant clinical effect and is worth being generalized.