湿性愈合理论在动静脉内瘘扣眼穿刺患者中的应用

Application of Moist Wound Healing Theory in Patients Undergoing Hemodialysis by Blunt Needle Buttonhole Puncture of Autogenous Arteriovenous Fistula

目的分析湿性愈合理论在动静脉内瘘扣眼穿刺患者中的应用现状及其优势。方法选取2019年1月至2021年6月成都中医药大学附属医院收治的采用扣眼穿刺法维持血液透析的60例患者为研究对象,按照随机数字表法分为试验组和对照组,每组30例。对照组采用传统方式祛痂,试验组采用水凝胶+水胶体敷料护理扣眼穿刺处。比较两组患者1周、1个月、3个月扣眼痂壳形成情况和经过3个月治疗后并发症发生情况、疼痛状况及生活质量指标。结果在1周、1个月、3个月治疗后试验组扣眼痂壳的发生率均低于对照组(P<0.05)。治疗3个月后,试验组皮下血肿、感染、穿刺点渗血的发生率及并发症总发生率均低于对照组(P<0.05);试验组视觉模拟疼痛评分法(VAS)评分明显降低,中、重度疼痛比例较对照组明显较少(P<0.05);试验组健康调查简表(SF-36)各项评分较对照组明显改善(P<0.05)。结论湿性愈合理论的运用可从一定程度上缓解动静脉内瘘扣眼穿刺的痂壳形成及并发症发生,改善患者的疼痛程度及生活质量。

Objective To analyze the application and value of moist healing theory in patients undergoing hemodialysis by blunt needle buttonhole puncture of autogenous arteriovenous fistula.Methods A total of 60 patients undergoing maintenance hemodialysis by blunt needle buttonhole puncture of autogenous arteriovenous fistula in the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine from January 2019 to June 2021 were selected as the research objects.They were randomly divided into experimental group(n=30)and control group(n=30).Traditional scab removal method was used in the control group,while hydrogel and hydrocolloid dressing was used to to care for the puncture site of the buttonhole in the experimental group.Scab shell formation at the buttonhole in the follow-up of 1week,1 month and 3 months after puncture was compared between the two groups.The incidence of complications,pain and quality of life indicators after 3 months of treatment were compared between the two groups.Results Rate of scab shell formation in the follow-up of 1 week,1 month and 3 months after puncture was lower in the experimental group than that in the control group(P<0.05).After 3 months of treatment,the incidence of subcutaneous hematoma,infection,bleeding at puncture site and total incidence of complications in the experimental group were lower than those in the control group(P<0.05).Compared with the control group,the experimental group had significantly lower visual analogue scale(VAS)score,lower proportion of patients with moderate and severe pain(P<0.05),and improved scores of the 36-Item Short Form Health Survey(SF-36)(P<0.05).Conclusion Application of moist healing theory can alleviate scab shell formation at the puncture site and lower the incidence of complications to a certain extent,thus improve the pain score and quality of life of patients undergoing maintenance hemodialysis by blunt needle buttonhole puncture of autogenous arteriovenous fistula.