血液透析患者动静脉内瘘穿刺相关痛苦体验的质性研究

doi:10.3761/j.issn.0254-1769.2025.19.004

摘要/Abstract

摘要：

目的了解血液透析患者动静脉内瘘穿刺相关痛苦的真实体验，为临床制订针对性的评估工具和干预方案提供依据。方法采用描述性现象学研究方法，应用目的抽样法于2024年11月—2025年1月选取常州市某三级甲等医院血液净化中心13例动静脉内瘘血液透析患者进行半结构化访谈，采用Colaizzi 7步分析法分析资料。结果共提炼了4个主题、10个亚主题：痛苦体验动态演变（认知空白与环境陌生引发痛苦、熟悉流程与自我管理缓解痛苦、突发医疗事件再次唤醒痛苦）；具身认知痛苦体验（躯体化痛苦、认知性痛苦、身心二元交互）；主观互动痛苦感知（穿刺技能差异的主观感受、良好沟通态度的正向调节）；痛苦体验应对策略（赋能性应对、适应性妥协）。结论血液透析患者动静脉内瘘穿刺相关痛苦并非单一的生理感受，而是涵盖身心交互、主观互动及应对的复杂体验，临床应构建动态评估与精准干预体系，以改善患者穿刺体验和生活质量。

关键词: 维持性血液透析, 动静脉内瘘, 穿刺相关痛苦, 质性研究, 护理

Abstract:

Objective To explore the authentic experiences of needle-related distress during arteriovenous fistula cannulation in hemodialysis patients and provide a basis for developing targeted assessment tools and intervention plans in clinical practice. Methods This study adopted a descriptive phenomenological research method. Using purposive sampling，13 hemodialysis patients with arteriovenous fistula from the blood purification center of a tertiary hospital in Changzhou were recruited for semi-structured interviews between November 2024 and January 2025. Data were analyzed using Colaizzi’s 7-step method. Results Totally 4 themes and 10 sub-themes were extracted，namely dynamic evolution of distressing experiences（cognitive gaps and unfamiliar environments triggering distress，familiarity with procedures and self-management alleviating distress，sudden medical events reawakening distress），embodied cognition of distressing experiences（somatic distress，cognitive distress，mind-body dualistic interaction），subjective interaction in distress perception（subjective perceptions of differences in puncture skills，positive regulation through good communication attitudes），coping strategies for distressing experiences （empowerment-based coping，adaptive compromise）. Conclusion The needle-related distress associated with arteriovenous fistula puncture in hemodialysis patients is not a single physical feeling，but a complex experience involving physical and mental interaction，nurse-patient interaction and coping strategies. Clinically，a dynamic assessment and precise intervention system should be constructed to improve patients’ puncture experience and quality of life.

Key words: Maintenance Hemodialysis, Arteriovenous Fistula, Needle-Related Distress, Qualitative Research, Nursing Care

王文倩, 牛洪艳, 李青枝, 胡璐璐. 血液透析患者动静脉内瘘穿刺相关痛苦体验的质性研究[J]. 中华护理杂志, 2025, 60(19): 2328-2332.

WANG Wenqian, NIU Hongyan, LI Qingzhi, HU Lulu. A qualitative study on needle-related distress of arteriovenous fistula experiences in hemodialysis patients[J]. Chinese Journal of Nursing, 2025, 60(19): 2328-2332.

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