改良式密闭回血法对维持性血液透析患者动静脉内瘘血栓形成风险的影响

Effect of modified airtight blood return method on risk of thrombosis of arteriovenous fistula in patients with maintenance hemodialysis

目的探讨应用改良式密闭回血法对降低维持性血液透析患者动静脉内瘘血栓形成风险的作用。方法选取2021年11月—2022年10月接受规律性血液透析患者50例为研究对象。2021年11月—2022年4月采用传统密闭式双向回血法为对照组,2022年5月—2022年10月采用改良式密闭回血法为改良组,比较2组患者下机后的血压、下机内瘘穿刺点按压时间、内瘘渗血率、血栓发生率、透析器内红细胞的残余量、回血总时间、回血生理盐水量。结果改良组下机回血量、下机回血时间、下机后血压、下机内瘘穿刺点按压时间、内瘘渗血率、下机回血的生理盐水量、内瘘血栓发生率、血液透析管路残余红细胞数均少于或低于对照组,差异均有统计学意义(P<0.05)。结论改良式密闭回血法可以缩短下机回血的时间,减少0.9%氯化钠溶液的需要量,降低了内瘘渗血率,缩短内瘘下机按压时间,减少下机后血液透析管路里红细胞的残余,等量生理盐水回血的同时充分降低了内瘘局部的血液黏滞度。

Objective To explore the role of modified airtight blood return method in reducing the risk of thrombosis of arteriovenous fistula in patients with maintenance hemodialysis.Methods A total of 50 patients with regular hemodialysis from November 2021 to October 2022 were selected as research objects.From November 2021 to April 2022,the patients with traditional airtight bidirectional blood return method were included in control group,while the patients with modified airtight blood return method from May 2022 to October 2022 were included in modified group.The blood pressure after removing the dialyzer,compression time at the arteriovenous fistula puncture site after removing the dialyzer,fistula leakage rate,incidence of thrombus,residual red blood cells in the dialyzer,total time for blood return and physiological saline volume used for blood return were compared between the two methods.Results In the modified group,blood return volume after removing the dialyzer,blood return time after removing the dialyzer,blood pressure after removing the dialyzer,compression time at the arteriovenous fistula puncture site after removing the dialyzer,fistula leakage rate,physiological saline volume used for blood return after removing the dialyzer,incidence of internal fistula thrombosis,and residual red blood cells in the dialyzer tube were significantly lower or shorter than those in the control group(P<0.05).Conclusion Modified airtight blood return method can shorten the blood return time after removing the dialyzer,decrease the consumption of 0.9%sodium chloride solution,reduce the fistula leakage rate,shorten the compression time at the arteriovenous fistula puncture site after removing the dialyzer,reduce residual red blood cells in the dialyzer tube after removing the dialyzer,and fully reduce the blood viscosity in the local area of the internal fistula under the condition of blood return with equivalent physiological saline.