扣眼法应用于动静脉内瘘穿刺的研究进展

综述了扣眼穿刺法建立扣眼隧道的方法,在国内外的应用状况,与其他动静脉内瘘穿刺方法的优缺点比较及其改进措施.提出扣眼穿刺法能有效防止动静脉内瘘并发症,制定并实施扣眼穿刺法的标准及操作规程、强化工作人员的理论知识和相关技能培训和患者的自我管理教育是有效降低感染风险的措施.     

动静脉内瘘穿刺处的止血方法

在血液透析治疗中，常用的血管通路首选动静脉内瘘。透析结束动静脉内瘘穿刺点止血时，一般使用绷带缠绕肢体止血，但此法如缠绕较紧患者肢体活动受限且影响周围组织的血液循环，如缠绕较松则起不到止血作用。我院自2003～2006年对使用内瘘透析的患者，全部使用弹力松紧布缝以粘扣的方法止血，效果较好，现介绍如下。     

顺血流穿刺法对维持性血液透析患者动静脉内瘘使用初期的影响

目的探讨维持性血液透析（maintenance hemodialysis,MHD）患者自体动静脉内瘘使用初期的最佳穿刺方法。方法将64例自体动静脉内瘘术后6～8周的MHD患者按随机数表法分为对照组和实验组。2组动脉出路选择距离吻合口3em以上的内瘘远心端,对照组32例选用传统穿刺法,即逆血流穿刺法;实验组32例采用顺血流穿刺法,2组静脉回路均为顺血流穿刺。观察内瘘最初4次使用情况,比较2组一次穿刺成功率、血肿发生率、血流量不足发生率及拔针后压迫止血时间,同时比较尿素氮下降率（urear reduction rare,URR）及单室模型尿素清除指数（singl—poolKt／V,spKt／V）。结果64例患者,每例行血液透析4次,2组分别记录血液透析128例次（32例×4次）、内瘘穿刺256例次（动脉出路穿刺128例次＋静脉回路穿刺128例次）。实验组动脉出路一次穿刺成功率为99．22％（127例次,127／128）显著高于对照组92．97％（119例次,119／128）（P〈O．01）,血肿发生率为2．34％（3例次,3／128）低于对照组8．59％（11例次,11／128）（P〈0．05）,拔针后压迫止血时间[（17．63±1．91）min-]显著少于对照组[（19．61±1．84）mini（P〈0．01）。实验组和对照组静脉回路一次穿刺成功率分别为99．22％（127例次,127／128）和96．88％（124例次,124／128）、透析血流量不足发生率分别为6．25％（8例次,8／128）和7．03％（9例次,9／128）;URR分别为（65．23％±2．93％）和（65．32％±2．41％）、spKt／V分别为（1．20±0．18）和（1．21±0．11）,2组比较,差异无统计学意义（P〉O．05）。结论自体动静脉内瘘使用初期采用顺血流穿刺法,不影响透析血流量及透析充分性,可提高动脉出路穿刺成功率、减少血肿发生、缩短拔针后内瘘压迫止血时间,配合相关护理措施,可减少内瘘相关并发症、保护内瘘成熟,可能延长内瘘使用寿命。     

薰香疗法缓解血液透析患者动静脉内瘘穿刺疼痛

目的探讨薰衣草薰香疗法对血液透析患者内瘘穿刺疼痛的影响。方法将82例维持性血液透析患者随机分为薰香组(n=42)和对照组(n=40),薰香组内瘘穿刺前嗅吸浓度1%薰衣草精油5min,对照组予空白嗅吸蒸馏水。结果薰香组内瘘穿刺时的VAS评分、状态焦虑(S-AI)评分显著低于对照组(均P0.05)。结论薰衣草薰香疗法能有效缓解维持性血液透析患者内瘘穿刺时疼痛和焦虑情绪。     

维持性血液透析患者动静脉内瘘正反方向穿刺对透析充分性及内瘘并发症的研究

血液透析是慢性肾衰竭尿毒症患者替代治疗的主要方法之一,而血管通路的建立是使血液透析能够顺利进行的先决条件,成功的动静脉内瘘穿刺是保证血流量和充分透析的必备条件.应该选择一种好的穿刺方法,既能保证足够的血流量,减少血管损伤,避免内瘘狭窄,延长其使用寿命,在不影响透析充分性的基础上又方便护士操作,提高穿刺成功率.     

血液透析者自体动静脉内瘘穿刺方法对并发症的影响

目的 观察并探讨自体动静脉内瘘穿刺方法对内瘘相关并发症的影响.方法 分析2010年1月至2012年12月在皖南医学院附属弋矶山医院血液净化中心使用自体动静脉内瘘进行维持性血液透析者60例.根据穿刺方法不同将其分为绳梯穿刺法组、扣眼穿刺法组和区域穿刺法组,每组各20例患者,比较持续性血液透析治疗12个月后三组患者内瘘阻塞发生率、假性血管瘤发生率以及血管狭窄发生率变化.结果 绳梯穿刺法和扣眼穿刺法组内瘘阻塞发生率、假性血管瘤发生率以及血管狭窄发生率均明显低于区域穿刺法组,而绳梯穿刺法组和扣眼穿刺法组差异无统计学意义.结论 绳梯穿刺法和扣眼穿刺法动静脉内瘘的并发症发生率明显低于区域穿刺法,临床上可根据患者内瘘血管情况选择适当的内瘘穿刺方法.     

护理干预对血液透析患者非常规动-静脉内瘘并发症的影响

目的 探讨护理干预对血液透析患者非常规动-静脉内瘘并发症的影响.方法 选择32例行非常规动-静脉内瘘手术的血液透析患者按随机数字表法分为观察组(18例)和对照组(14例).观察组采用系统化护理干预,对照组采用常规护理,追踪观察12个月,比较2组患者护理后首次穿刺成功率、透析中的血流量、血管通路的并发症.结果 观察组患者经护理干预后首次穿刺成功率和透析中的血流量与对照组比较差异有统计学意义(P＜0.01);观察组患者血管通路并发症假性血管瘤形成和血管狭窄与对照组比较差异也有统计学意义(P＜0.01);观察组患者局部血管硬化发生情况与对照组比较差异有统计学意义(P＜0.05).结论 系统化地护理干预能够促进非常规动-静脉内瘘的成熟,明显减少内瘘并发症,提高了非常规动-静脉内瘘的使用寿命.     

健康教育对动静脉内瘘穿刺方法选择及效果的影响

目的：研究健康教育对动静脉内瘘（内瘘）穿刺方法选择及效果的影响。方法：对36例采用内瘘穿刺进行维持性血液透析的患者进行对照研究。对照组（A组,15例）采用常规健康教育,观察组（B组,21例）在常规健康教育基础上进行穿刺方法的教育,最后对穿刺方法的选择及效果进行对比。结果：B组对绳梯法或钮扣法穿刺的选择上明显高于A组（P〈0.01）;效果方面B组血流量明显高于A组（P〈0.05）,渗血或血肿及血管并发症的发生率明显低于A组（P〈0.05,P〈0.01）。结论：健康教育有利于患者选择正确的内瘘穿刺方法,并提高了动静脉内瘘的效果。     

内瘘穿刺方向对自体动静脉内瘘功能的影响

目的 探讨内瘘穿刺方向对自体动静脉内瘘功能的影响.方法 将150例使用自体动静脉内瘘的维持性血液透析患者随机分为三组各50例,分别采用向心穿刺(顺穿)、离心穿刺(反穿)和顺反穿交替的方式进行内瘘穿刺,比较2年后三组透析充分率、内瘘假性动脉瘤及狭窄发生情况.结果 最终完成研究143例.三组透析充分性比较,差异无统计学意义(P＞0.05);三组内瘘假性动脉瘤和狭窄发生率比较,差异有统计学意义(均P＜o.05),反穿组假性动脉瘤发生率最高,顺穿组内瘘狭窄发生率最高.结论 顺反穿交替穿刺技术在不影响透析效果的前提下,可有效降低自体动静脉内瘘动脉瘤和狭窄的发生.     

动静脉内瘘穿刺处的止血方法

在血液透析治疗中,常用的血管通路首选动静脉内瘘.透析结束动静脉内瘘穿刺点止血时,一般使用绷带缠绕肢体止血,但此法如缠绕较紧患者肢体活动受限且影响周围组织的血液循环,如缠绕较松则起不到止血作用.     

Comparison of one-stage and two-stage upper arm brachiobasilic arteriovenous fistula in the Vascular Quality Initiative

Objective

An upper arm brachiobasilic arteriovenous fistula (BBAVF) is a reliable autogenous hemodialysis access created with a one-stage or two-stage technique. Although both techniques are variably used, the optimal approach is uncertain. In this study, we compared the outcomes of one-stage and two-stage BBAVF procedures.

A multicentre analysis of the outcome of arteriovenous fistula in maintenance haemodialysis

Introduction: Arteriovenous fistulas (AVF) are the preferred choice for vascular access in hemodialysis. We aim to identify factors that may contribute to AVF failure. Methods: Data regarding AVF survival were collected from 441 patients. All AVFs were either radial or brachial, of the end-to-side variety. Parameters studied were age, gender, diabetes mellitus, hypertension prior to end-stage kidney disease (ESKD), site of fistula, blood flow rate, venous pressure, dialysis vintage and frequency, needle gauge used during dialysis, year of fistula creation, and details of fistula failure. Findings: The 6-month, 1-year and 2-year AVF survival rates were 98.41%, 95.01%, and 89.57%. Failure rates were 17.2%, 5.5%, 26.8%, and 14.4% for dominant radial, non-dominant radial, dominant brachial and non-dominant brachial respectively (P < 0.001). Using a larger needle size had better AVF survival rate (P < 0.05). All other factors had no significant correlation with AVF failure. Conclusion: There were no statistically significant differences in AVF patency with respect to gender, age, blood flow rate, presence of diabetes mellitus or systemic hypertension. A distally placed AVF in the nondominant arm had the best survival rate. Using a larger needle size, specifically 15G during dialysis, was associated with lowest AVF failure.     

Acute paraplegia in patient with spinal dural arteriovenous fistula after lumbar puncture and steroid administration: A case report

Introduction and importanceSpinal dural arteriovenous fistula (SDAVF) is an uncommon cause of longitudinal extensive transverse myelitis (LETM). It usually presents with vague congestive myelopathy symptoms and diagnosis is usually difficult on initial presentation. Common daily neurological interventions can aggravate the underlying pathophysiology leading to undesirable acute neurological deterioration. Intravenous steroids administration and lumbar (LP) puncture as a diagnostic tool are amongst the most commonly reported aggravating interventions. This rare case presentation highlights this association with its negative impact on the patient outcome in misdiagnosed cases.Case presentationThe authors present a sixty-eight-year-old male with paraplegia following steroid administration and LP for presumed inflammatory/autoimmune LETM in the setting of misdiagnosed SDAVF. The absence of flow voids on the conventional T2-weighted magnetic resonance image (MRI) lead to misdiagnosis. He had satisfactory neurological recovery few hours after surgical disconnection.Clinical discussionSDAVF is known to cause congestive myelopathy symptoms. Spinal angiogram is the gold standard for diagnosis. Although the exact mechanism is not fully understood, misdiagnosed cases like our case can develop severe neurological deterioration with steroid administration and lumbar puncture.ConclusionAlthough SDAVF is an uncommon cause of LETM, Clinicians should carefully exclude it before proceeding to steroid administration or performing LP as they can lead to devastating neurological deterioration.     

Portal arteriovenous fistula following partial gastrectomy

An emergency transthoracic transection of the esophagus was performed on a 62 year old man for hematemesis caused by rupture of esophageal varices. Hepatic functional reserve of this patient was classified as Child C. Postoperative celiac arteriography revealed an arteriovenous fistula between a branch of the gastroduodenal artery and a branch of the superior mesenteric vein. He had undergone a partial gastrectomy with Billroth II reconstruction 15 years earlier. Bleeding from the esophageal varices did not recur, but he subsequently died of liver failure. In some areas of the liver the microscopic changes were similar to those occurring in cirrhosis, but in most areas they resembled those seen in congestive liver fibrosis. This case suggested that portal arteriovenous fistula is an important predisposing cause leading to deterioration of liver function.     

自体动静脉内瘘并发医源性动脉瘤的原因分析与护理对策

目的探讨自体动静脉内瘘穿刺后并发医源性动脉瘤的原因和护理措施。方法对13例自体动静脉内瘘穿刺后合并动脉瘤的原因进行分析,并根据病情给予相应护理。结果13例中5例给予手术切除,其余8例采取保守治疗,均获得满意效果。结论医源性动脉瘤是因手术方式及长期反复穿刺自体动静脉内瘘造成的严重并发症,关键在于预防,应根据患者内瘘具体情况选择合理的操作方式,加强护理,预防早期动脉瘤,减少并发症发生。     

Effect of galectin-3 in the pathogenesis of arteriovenous fistula stenosis formation

ObjectiveThis study sought to investigate the effect of local expression of galectin-3 in the development of stenotic arteriovenous fistula (AVF).MethodsWe collected stenotic venous tissues, adjacent nonstenotic venous tissues, and blood samples from end-stage renal disease (ESRD) patients with AVF stenosis, while normal venous tissues and blood samples were collected from ESRD patients before AVF creation as controls. Also blood samples were collected from ESRD patients with nonstenosis functional AVF. Galectin-3, proliferating cell nuclear antigen (PCNA), matrix metalloproteinase-9 (MMP-9), and α-SMA expression in the venous tissues were examined by immunohistochemistry, and the ERK1/2 pathway activity in the intima was accessed by western blot. Serum galectin-3 level was measured by ELISA. Thereafter, human pulmonary arterial smooth muscle cells (HPASMCs) were cultured in vitro, and the interaction between Galectin-3 and ERK1/2 pathway in HPASMCs was estimated by western blot.ResultsESRD patients with stenotic AVF had a significant higher serum galectin-3 level than normal controls, and patients with non-stenotic functional AVF. The expression levels of galectin-3, phosphorylated ERK1/2, PCNA, MMP-9, and α-SMA in the stenotic venous tissues were higher than that in the normal venous tissues or the adjacent nonstenotic AVF venous tissues. Correlation analysis showed that the expression of galectin-3 of the neointima was positively correlated with PCNA and α-SMA in the stenotic AVF venous tissues. In HPASMCs, galectin-3 can increase the activity of phosphorylated ERK1/2 and promote the expression of α-SMA.ConclusionIn the stenotic AVF of ESRD patients, expression of the galectin-3 was significantly increased, showing a positive relation with neointima development.     

Comparison of wound complications between one-stage and two-stage brachiobasilic arteriovenous fistula: A meta-analysis

Research assessing the outcome of brachiobasilic arteriovenous fistulas (BB-AVF) after a one- and two-stage technique was conducted. A strict review of the comprehensive literature up to May 2023 was carried out using four databases-PubMed，Embase, Cochrane Library and web of science. Inclusion and exclusion criteria developed for the study were then applied to assess the quality of the literature, it was decided to review 12 interrelated studies.95% confidence intervals (Cl) and odds ratios (OR) were calculated using fixed effects models. The data were meta-analysed using RevMan 5.3 software. The results showed that two-stage technique with BB-AVF reduced surgical site haematoma (SSH) formation, (OR, 2.28; 95% CI, 1.24–4.17, p = 0.008), and also reduced surgical site wound infection (SSWI) (OR, 1.86; 95% CI, 1.17–2.94, p = 0.008). There are, however, several small sample sizes in the selected studies for this meta-analysis, so caution should be used when processing their values. There are more high-quality studies with large sample sizes that should be considered for future meta-analyses.     

超声在动静脉内瘘并发症中的应用进展

动静脉内瘘(AVF)是终末期肾病患者最常用的透析通路,但在建立及透析过程中易出现各种并发症,常见者包括内瘘成熟障碍、内瘘狭窄及血栓形成等。早期发现AVF并发症并适当干预、保持通路畅通,可改善终末期肾病患者预后。超声检查可评估及辅助AVF成熟、早期发现AVF常见并发症并辅助介入治疗等。本文就超声在AVF并发症中的应用进展进行综述。