两种拔针顺序对透析后动静脉内瘘出血的影响

目的探讨恰当的拔针顺序，减少内瘘并发症，为延长动静脉内瘘使用时间提供依据。方法采用方便取样的方法对80例内瘘穿刺后应用不同拔针顺序进行维持性血液透析的患者进行观察。密闭式回血下机后，一种方法是根据过去传统经验先拔动脉穿刺针，另一种方法是根据实际情况先拔静脉穿刺针。对两组动静脉内瘘的止血按压时间及内瘘并发症的发生率进行比较。结果（1）先拔静脉穿刺针组在止血按压时间（9．47min）、穿刺点出血量（0．23m1）方面优于先拔动脉穿刺针组（19．87min、4．82ml），比较差异有统计学意义（Z值分别为3．801，1．901；P均〈0．01）。（2）先拔静脉穿刺针组皮下血肿、渗血的发生率（0．oo％，10．50％）低于先拔动脉穿刺针组（3．00％，31．00％），比较差异均有统计学意义（x^2值分别为136．98，84．25；P均〈0．01）。结论先拔静脉针更能达到有效止血目的，从而避免内瘘因压迫不当而出血及渗血，减少了并发症的发生，能够更好地保护动静脉内瘘，延长其使用寿命。

Effect of two kinds of pulling needle order on the arteriovenous fistula bleeding after dialysis

Objective To explore the proper pulling needle order so as to reduce the complication of arteriovenous fistula and provide evidence for increasing the use time of arteriovenous fistula. Methods Totals of 80 cases were recruited and divided into traditional pulling group and new pulling group,with 40 case in each group. In the traditional pulling group, the arterial puncture needles were pulled first, while the venous puncture needles were pulled first in new pulling group. Then, the hemostasis press time and the complications incidence of arteriovenous fistula were observed. Results The hemostasis press time and bleeding volume of new pulling group were lower than that of traditional pulling group（9.47 min vs 19.87 min, 0.23 ml vs 4.82 ml） ,and the difference was statistically significant （ P 〈 0.01 ）. The incidence of hematoma and bleeding of new pulling group （0.00% and 10.50% ） was lower than that of the control group（3.00% ,31.00% ） ,and the difference was statistically significant （ P 〈 0.01 ）. Conclusions The new technology of pulling the venous puncture needles can achieve the aim of effective hemostasis, reduce the complication of artefiovenous fistula, which can protect the arteriovenous fistula better and prolong its use time.