彭愛(ài)平 張劉兵 康文惠

【摘要】 目的：探究改良式定點(diǎn)穿刺在維持性血液透析患者中的應(yīng)用情況。方法：選取2017年12月-2018年12月本院收治的83例維持性血液透析患者，依據(jù)隨機(jī)數(shù)字表法將其分為對(duì)照組41例和觀(guān)察組42例。對(duì)照組采用常規(guī)定點(diǎn)穿刺，觀(guān)察組采用改良式定點(diǎn)穿刺。比較兩組患者的穿刺情況、穿刺并發(fā)癥的發(fā)生情況。結(jié)果：觀(guān)察組患者穿刺成功率為99.32%，高于對(duì)照組的98.33%，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。觀(guān)察組1年后穿刺時(shí)的疼痛評(píng)分明顯低于對(duì)照組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。開(kāi)瘺1個(gè)月及1年后，兩組穿刺血管內(nèi)徑、內(nèi)瘺血液流速比較，差異均無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05）。觀(guān)察組穿刺后滲血發(fā)生率為4.75%，低于對(duì)照組的21.93%，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。觀(guān)察組患者穿刺后感染、皮下血腫和動(dòng)脈瘤發(fā)生率均明顯低于對(duì)照組，差異均有統(tǒng)計(jì)學(xué)意義（P<0.05）。結(jié)論：改良式定點(diǎn)穿刺可以有效提高維持性透析患者穿刺成功率，降低疼痛程度，減少滲血、內(nèi)瘺感染、皮下血腫等并發(fā)癥的發(fā)生情況，且通過(guò)開(kāi)瘺1個(gè)月及1年后血管內(nèi)徑值對(duì)比，并不會(huì)造成內(nèi)瘺狹窄從而導(dǎo)致血流減少。

【關(guān)鍵詞】 改良式定點(diǎn)穿刺 維持性血液透析 內(nèi)瘺狹窄

[Abstract] Objective： To explore the application of modified fixed-point puncture in maintenance hemodialysis patients. Method： A total of 83 patients with maintenance hemodialysis admitted to our hospital from December 2017 to December 2018 were selected. According to the random number table method， they were divided into control group 41 cases and observation group 42 cases. Conventional fixed-point puncture was used in the control group， and modified fixed-point puncture was used in the observation group. The puncture conditions and the incidence of puncture complications were compared between the two groups. Result： The puncture success rate in the observation group was 99.32%， higher than 98.33% in the control group， the difference was statistically significant （P<0.05）. The pain score at puncture 1 year later in the observation group was significantly lower than that in the control group， the difference was statistically significant （P<0.05）. Comparison of puncture vessel diameter and fistula blood flow rate between the two groups 1 month and 1 year after fistula opening， the differences were not statistically significant （P>0.05）. The incidence of infiltration in the observation group was 4.75%， lower than 21.93% in the control group， the difference was statistically significant （P<0.05）. The incidence of post-puncture infection， subcutaneous hematoma and aneurysm in the observation group were significantly lower than those in the control group， the differences were statistically significant （P<0.05）. Conclusion： The modified fixed-point puncture can effectively improve the success rate of puncture， reduce the degree of pain， reduce the incidence of complications such as blood leakage， internal fistula infection， subcutaneous hematoma， and through the comparison of the internal diameter of blood vessels after 1 month and 1 year after opening the fistula， it will not cause the complications of reduced blood flow caused by stenosis of internal fistula.

綜上所述，改良式定點(diǎn)穿刺可以有效提高維持性透析患者穿刺成功率，降低疼痛程度，減少穿刺點(diǎn)感染、穿刺針滲血、血腫、假性動(dòng)脈瘤等并發(fā)癥發(fā)生。

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（收稿日期：2020-02-24） （本文編輯：姬思雨）