摘要
目的观察锐针绳梯穿刺法与钝针扣眼穿刺法对患者透析效果、穿刺疼痛、穿刺点压迫止血时间及血肿等影响,为血透室选择合理的穿刺工具和穿刺方法提供理论依据。方法采用自身前后对比方法,选择本院维持性血液透析患者20名,在2016年1~4月进行为期4个月的临床研究。分为锐针绳梯组(简称锐针组)和钝针扣眼组(简称钝针组),2组穿刺例次均为250次,比较2种方法在透析血流量及静脉压、KT/V(肌酐尿素清除率)的差异,观察2种穿刺法并发症(疼痛、血肿)发生率及穿刺点压迫止血时间。结果 2种方法血流量、透析中静脉压、KT/V值没有统计学差异(P>0.05)。钝针组患者的疼痛感受明显低于锐针组,疼痛评分较锐针穿刺组低,差异具有统计学意义(P<0.05)。透析结束穿刺点的压迫时间钝针组也明显短于锐针组,差异有统计学意义(P<0.05)。钝针扣眼穿刺内瘘血肿的发生率也明显低于锐针绳梯穿刺,差异有统计学意义(P<0.05)。结论钝针扣眼穿刺能达到有效的透析效果,减轻病人穿刺时的痛苦,减少内瘘血肿的发生,缩短内瘘穿刺点压迫时间,更好的保护动静脉内瘘,提高患者生活质量,值得在临床推广应用。
Objective To observe the effect of blunt needle buttonhole puncture and sharp needle ladder puncture on the quality of patients hemodialysis, puncture pain,the compression time of puncture point and hematoma. It provides a theoretical basis to help dialysis department choose the reasonable puncture tool and method. Methods From January to April in 2016 ,we chosed 20 patients in our hospital who were in maintenance hemodialysis to compare their own conditions during the four - month clinical reserch. We divided into 2 groups, sharp needle ladder group（ referred to as sharp needle group）and blunt needle buttonhole group（ referred to as blunt needle group） , the puncture cases of each group were 250 times. We compared the difference between the two puncture methods on blood flow, venous pressure and KT/V （ creati- nine urea clearance rate）and observed the incidence of complications （pain, hematoma）and puncture point compression time of the two punc- ture methods, Results There were no significant difference in blood flow, venous pressure and KT/V between the two methods （ P 〉 0.05 ） , Pain perception was significantly lower in the patients with blunt needle group than in the acute group（ P 〈 0. 05 ） , and the pain score was low- er than that of the sharp needle puncture group. The compression time of the puncture point was also significantly shorter than that of the sharp needleand（ P 〈 0.05 ）. The incidence rate of hematoma of fistula in blunt needle buttonhole group was also lower than the sharp needle group significantly（P 〈 0.05 ）. Conclusion The blunt needld buttonhole puncture not only achieve effective dialysis effect but also relieve the pa- tients ＇ pain, reduce the incidence rate of internal fistula hematoma and the time of fistula puncture point pressing. It＇ s better to protect the ar- teriovenous fistula and enhance the quality of life, and is worthy developing in clinical application.
关键词
维持性血液透析
钝针扣眼穿刺
锐针绳梯穿刺
动静脉内瘘
Maintenance Hemodialysis
Blunt needle buttonhole puncture
sharp needle
ladder puncture
Arteriovenous fistula
