三种不同的内瘘穿刺法在血液透析中的应用比较

目的：比较普通穿刺、钝针扣眼穿刺和新型钝针扣眼穿刺等三种不同的动静脉内瘘穿刺法对血液透析患者的影响。方法：将60例采用动静脉内瘘作为血管通路的血液透析患者随机分为A（普通穿刺）、B（钝针穿刺）、C（新型钝针穿刺）三组,各20例。6个月后,比较三组患者穿刺相关并发症、各生化指标和透析充分性。并对影响穿刺并发症的相关因素进行多变量COX回归模型分析。结果：C组穿刺点剧痛、内瘘狭窄的发生率低于A、B组,而内瘘血肿、假性动脉瘤的发生率低于A组（P均〈0.05）;6个月后C组患者CRP水平低于A、B组,HGB水平高于A、B组（P均〈0.05）,组间URR、Kt/V水平差异无统计学意义（P均〉0.05）;多变量COX回归模型分析：影响内瘘穿刺并发症的主要因素是透析龄、HGB、CRP。结论：新型钝针扣眼穿刺法能明显降低透析患者穿刺点血肿、假性动脉瘤、血管狭窄的发生率,减轻透析患者的微炎症状态,且不影响透析充分性;内瘘穿刺的并发症可能与透析龄、HGB、CRP水平密切相关。

Compare of Three Kinds of Fistula Puncture Methods in Hemodialysis Application

Objective：Comparison of arteriovenous fistula puncture general,the impact of blunt needle puncture and improved buttonhole buttonhole blunt needle puncture of maintenance hemodialysis patients,and choose a safe and effective method of fistula puncture.Methods：The 60 cases with arteriovenous fistula as vascular access in hemodialysis patients were randomly divided into A（20cases,ordinary puncture）,B（20cases,blunt needle puncture）,C（20cases,improved blunt needle puncture）three groups.Comparison puncture related complications of various biochemical markers and dialysis adequacy of three groups patients after six months.And analysis of complications related factors of puncture use multivariate COX regression.Results：The incidence of Puncture site pain and fistula stenosis of group C were lower than group A and B.And the incidence of fistula hematoma,pseudoaneurysm were lower than group A（P〈0.05all）.The group C patients with CRP levels were lower than group A and B,HGB levels were higher than group A and B after six months（P〈0.05all）.COX multivariate regression analysis indicated that the main factors of affected fistula puncture complications were dialysis age,HGB and CRP levels.Conclusion：The improved grommets blunt needle puncture method can significantly reduce the incidence of dialysis puncture site hematoma,pseudoaneurysm and stenosis,and reduce Micro-inflammation of dialysis patients.and did not affect dialysis adequacy.Fistula puncture complications may be associated with dialysis age,HGB and CRP levels.