王榕

[摘要]目的 探討大角度進(jìn)針?lè)ㄅc小角度進(jìn)針?lè)ㄔ趧?dòng)靜脈內(nèi)瘺患者維持性血液透析治療中的臨床價(jià)值。方法 選取2018年8月1日～11月30日我院收治的118例動(dòng)靜脈內(nèi)瘺患者作為研究對(duì)象，按照隨機(jī)數(shù)字表法將其分為大角度進(jìn)針組與小角度進(jìn)針組，每組各59例。大角度進(jìn)針組采用特定專人建立隧道并采用大角度進(jìn)針穿刺的方法;小角度進(jìn)針組采用小角度進(jìn)行進(jìn)針穿刺的治療方法。治療結(jié)束后，比較兩組患者穿刺治療的臨床情況、穿刺疼痛程度以及不良反應(yīng)總發(fā)生率。結(jié)果 大角度進(jìn)針組患者的穿刺點(diǎn)滲血率低于小角度進(jìn)針組，大角度進(jìn)針組患者的一次穿刺成功率高于小角度進(jìn)針組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）;兩組患者的穿刺點(diǎn)感染率比較，差異無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05）;兩組患者的穿刺次數(shù)比較，差異無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05）。大角度進(jìn)針組患者的疼痛評(píng)分低于小角度進(jìn)針組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。大角度進(jìn)針組患者的不良反應(yīng)總發(fā)生率低于小角度進(jìn)針組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。結(jié)論 大角度進(jìn)針的穿刺治療方法在動(dòng)靜脈內(nèi)瘺的治療中可提高患者的穿刺治療成功率，降低穿刺點(diǎn)滲血率，減輕穿刺點(diǎn)的疼痛程度，減少不良反應(yīng)發(fā)生率。

[關(guān)鍵詞]大角度進(jìn)針;小角度進(jìn)針;穿刺治療;穿刺點(diǎn)滲血

[中圖分類號(hào)] R473.71? ? ? ? ? [文獻(xiàn)標(biāo)識(shí)碼] A? ? ? ? ? [文章編號(hào)] 1674-4721（2019）10（a）-0246-04

[Abstract] Objective To explore the clinical value of large-angle needling method and small-angle needling method in maintenance hemodialysis treatment for arteriovenous fistula patients. Methods A total of 118 patients with arteriovenous fistula admitted to our hospital from August 1 to November 30 2018 were selected as subjects. They were divided into large angle needle insertion group and small angle needle insertion group according to the random number table method， with 59 patients in each group. The large-angle needle insertion group were established a tunnel by a special person and adopted a large-angle needle insertion method. The small-angle needle insertion group adopted the treatment method of needle insertion puncture at a small angle. After treatment， the clinical situation of puncture treatment， degree of puncture pain and the total incidence of adverse reactions of the two groups were compared. Results The penetration rate of puncture point in patients with large-angle needle insertion group was lower than that in patients with small-angle needle insertion group， the difference was statistically significant （P<0.05）. The success rate of one-time puncture in patients with large-angle needle insertion group was higher than that in patients with small-angle needle insertion group， and the difference was statistically significant （P<0.05）. There was no statistically significant difference in the infection rate of puncture point between the two groups （P>0.05）. There was no significant difference in puncture times between the two groups （P>0.05）. The pain score of patients in the large-angle acupuncture group was significantly lower than that in the small-angle acupuncture group， the difference was statistically significant （P<0.05）. The pain degree of puncture point in patients with large angle group was lower than that in patients with small angle needle insertion group， and the difference was statistically significant （P<0.05）. The total incidence of adverse reactions in the large-angle needle insertion group was lower than that in the small-angle needle insertion group， the difference was statistically significant （P<0.05）. Conclusion The puncture treatment method of large angle needle insertion can improve the success rate of puncture treatment for patients with arteriovenous fistula， reduce bleeding from the puncture point， reduce degree of pain at the puncture point， and reduce the incidence of adverse reactions.

綜上所述，大角度進(jìn)針在動(dòng)靜脈內(nèi)瘺維持性血液透析治療患者的治療中穿刺成功率較高，可以減少穿刺點(diǎn)滲血率，減輕患者的疼痛程度，減少患者的不良反應(yīng)發(fā)生率，提高治療質(zhì)量。

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（收稿日期：2018-02-22? 本文編輯：焦曌元）