多单穿刺技术在维持性血液透析患者自体动静脉内瘘穿刺中的应用

doi:10.3761/j.issn.0254-1769.2025.18.006

摘要/Abstract

摘要：

目的比较不同穿刺技术在血液透析患者自体动静脉内瘘穿刺中的应用效果，为护士选择适宜的穿刺方法提供参考。方法选取2023年9月—2024年9月在常州市某三级甲等综合医院行血液透析的135例患者作为研究对象，根据穿刺方法随机分为多单穿刺组、绳梯穿刺组、扣眼穿刺组，每3个月随访1次，并比较3组一次穿刺成功率、穿刺疼痛、穿刺点血痂直径、止血时间及内瘘并发症（感染、栓塞、动脉瘤、狭窄、内膜增生）的差异。结果共114例患者完成了该研究，多单穿刺组40例，绳梯穿刺组42例，扣眼穿刺组32例。多单穿刺组（99.4%）和扣眼穿刺组（99.6%）的一次穿刺成功率高于绳梯穿刺组（93.3%），均P<0.001；扣眼穿刺组血痂直径（2 mm）大于多单穿刺组（1 mm）和绳梯穿刺组（1 mm），均P<0.001；扣眼穿刺组的内膜增生发生率（34.3%）高于多单穿刺组（10.0%）和绳梯穿刺组（11.9%），均P<0.05。结论 3种动静脉内瘘穿刺技术各有优缺点，多单穿刺能够提高一次穿刺成功率，与绳梯穿刺和扣眼穿刺比较，未明显增加内瘘并发症，可在临床推广使用。

关键词: 维持性血液透析, 自体动静脉内瘘, 穿刺, 护理

Abstract:

Objective To compare the application effects of different puncture techniques in the autonomous arteriovenous fistula puncture of patients undergoing hemodialysis，providing a reference for nurses in selecting puncture methods. Methods A total of 135 patients undergoing hemodialysis at a tertiary hospital in Changzhou from September 2023 to September 2024 were selected and randomly divided into 3 groups，including a multiple puncture group，a rope ladder puncture group，and a buttonhole puncture group. Follow-up was conducted every 3 months，and the first puncture success rate，puncture pain，diameter of blood scab at the puncture site，hemostasis time，and complications of arteriovenous fistula（infection，embolism，aneurysm，stenosis，intimal hyperplasia） were compared among the 3 groups. Results A total of 114 patients completed the study，with 40 in the multiple puncture group，42 in the rope ladder puncture group，and 32 in the buttonhole puncture group. The single-puncture success rate was higher in the multiple single-puncture group（99.4%） and the buttonhole puncture group（99.6%） than it in the rope-ladder puncture group（93.3%），with all P<0.001. The scab diameter in the buttonhole puncture group（2 mm） was larger than that in the multiple single-puncture group（1 mm） and the rope-ladder puncture group（1 mm），with all P<0.001. The incidence of intimal hyperplasia in the buttonhole puncture group（34.3%） was higher than that in the multiple single-puncture group（10.0%） and the rope-ladder puncture group（11.9%），with all P<0.05. Conclusion Each of the 3 arteriovenous fistula puncture techniques has its advantages and disadvantages. The multiple puncture group technique can improve the first puncture success rate，and it does not significantly increase the complications of arteriovenous fistula compared to the rope ladder and buttonhole techniques，making it suitable for widespread use.

Key words: Maintenance Dialysis, Autonomous Arteriosclerosis Fistula, Punctures, Nursing Care

孙琳, 牛洪艳, 胡璐璐, 赵秀明, 黄丽. 多单穿刺技术在维持性血液透析患者自体动静脉内瘘穿刺中的应用[J]. 中华护理杂志, 2025, 60(18): 2210-2215.

SUN Lin, NIU Hongyan, HU Lulu, ZHAO Xiuming, HUANG Li. Application of multiple needle puncture technique in autonomous arteriosclerosis fistula puncture in maintenance dialysis patients[J]. Chinese Journal of Nursing, 2025, 60(18): 2210-2215.

图/表 4

表1 3组一般资料的比较

Table 1 Comparison of baseline variables of 3 groups

表2 3组一次穿刺成功率的比较

Table 2 Comparison of first puncture success rates among 3 groups

表3 3组患者穿刺点疼痛、血痂直径及止血时间的比较[M（P25，P75）]

Table 3 Comparison of puncture site pain， diameter of blood scab and hemostat time among 3 groups of patients[M（P25，P75）]

表4 3组内瘘并发症发生率的比较[例（百分率，%）]

Table 4 Comparison of the incidence of arteriosclerosis fistulas complications among 3 groups[case（percentage，%）]

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