改良绳梯式穿刺和钝针扣眼穿刺在血液透析患者新建内瘘中的应用效果

Effect of modified rope-ladder puncture and blunt-needle buttonhole puncture in new internal fistula of hemodialysis patients

目的探讨改良绳梯式穿刺和钝针扣眼穿刺在血液透析患者新建内瘘中的应用效果。方法采用便利抽样法,选取2019年3月—2020年5月在长治医学院附属和平医院行维持性血液透析治疗的70例患者作为研究对象,按照随机数字表法分观察组(40例)和对照组(30例)。对照组采用钝针扣眼穿刺,观察组采用改良绳梯式穿刺。比较两组患者的穿刺情况、疼痛感受、拔针后止血时间、穿刺并发症以及内瘘相关并发症发生情况。结果两组的一次穿刺成功率比较,差异无统计学意义(P>0.05);观察组的穿刺疼痛程度重于对照组,差异有统计学意义(P<0.05);观察组的穿刺点平均按压止血时间长于对照组,差异有统计学意义(P<0.05);观察组的穿刺并发症发生率高于对照组,差异有统计学意义(P<0.05);透析治疗1年内,观察组的内瘘并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论改良绳梯式穿刺与钝针扣眼穿刺方案的一次穿刺成功率相近,钝针扣眼穿刺造成的疼痛较轻,止血时间较短,穿刺并发症发生率较低,但改良绳梯式穿刺对患者内瘘功能影响更小。

Objective To explore the effect of modified rope-ladder puncture and blunt-needle buttonhole puncture in new internal fistula of hemodialysis patients.Methods From March 2019 and May 2020,a total of 70 patients undergoing maintenance hemodialysis in Heping Hospital Affiliated to Changzhi Medical College were enrolled using convenience sampling method and divided to the observation group(40 cases)and the control group(30 cases)by random number table method.The control group received blunt-needle buttonhole puncture and the observation group conducted modified rope-ladder puncture.The puncture situations,pain,hemostasis time after needle withdrawal,occurrence of puncture complications and internal fistula related complications were compared between the two groups.Results There was no significant difference in success rate of one-time puncture between the two groups(P>0.05).The puncture pain of the observation group was severe than that of the control group(P<0.05),average pressing time at puncture sites was longer than that of the control group(P<0.05),and incidence of puncture complications was higher than that of the control group(P<0.05).Within one year of dialysis treatment,the incidence of internal fistula complications of the observation group was lower than that of the control group(P<0.05).Conclusions The success rate of one-time puncture between modified rope-ladder puncture and blunt-needle buttonhole puncture are similar.The pain caused by blunt-needle buttonhole puncture is milder,hemostasis time is shorter and incidence of puncture complications is lower.However,the modified rope ladder puncture has less influence on the internal fistula function of patients.