动静脉直接穿刺在血液透析中的应用研究

目的探讨血液透析患者临时血管通路选择的相关因素。方法对106例以直接动静脉穿刺和55例以深静脉置管为血管通路进行血液透析的患者进行研究,比较两组患者血液透析血肌酐、血尿素氮清除率、血液透析血流量、建立血管通路需要费用、建立血管通路时间,以及出血、血肿、疼痛明显、感染、恐惧感、穿刺失败等并发症情况。结果在血液透析中直穿组的血肌酐及血尿素氮清除率明显高于静脉置管组(P<0.001);透析血流量两种血管通路差异无显著性意义(P=0.051);深静脉置管所需费用远高于直穿(P<0.001);深静脉置管建立血管通路所需时间远多于直穿(P<0.001)。在两种血管通路并发症的比较中,深静脉胃管组患者有明显恐惧感,而动静脉直接穿刺组患者疼痛感明显增多。出血、血肿、感染及穿刺失败率等并发症两组比较差异无显著性意义。结论直接动静脉穿刺方便、快捷、经济,是过渡性血透患者进行透析治疗临时血管通路的较好选择。

Applied study of directly artery and intravenous puncture for hemodialysis treatment

Objective To explore the choice of temporary vascular access in hemodialysis patients and its' relevant factors. Methods 106 cases with arteriovenous direct puncture and 55 cases of deep venous catheters for vascular access for hemodialysis patients was selected in the study.The clearance ratio of serum creatinine and blood flow in hemodialysis,the cost and time of establishment of vascular access,as well as bleeding,hematoma,obvious pain,infection,fear,failure of puncture were observed and compared between the two groups.Results The clearance ratio of serum creatinine and blood urea nitrogen were significantly higher in the group with arteriovenous direct puncture than that of deep venous catheter group(P<0.001).The group of deep venous catheter was obviously fear and pain in patients with arteriovenous direct puncture markedly increased.Bleeding,hematoma,infection and failure of puncture were no difference between the two groups.Conclusion Arteriovenous direct puncture was convenient,fast and economy,and is the better choice of vascular access for the transitional dialysis patients.