疑难内瘘患者穿刺方法的改良及应用

目的 探讨零压力改良穿刺法在疑难内瘘患者穿刺中的应用效果。 方法 选取2014年1月—2016年4月某三级甲等医院血液透析中心126例疑难内瘘患者,随机分成试验组（64例）和对照组（62例）,试验组采用零压力改良穿刺法,对照组采用常规穿刺方法,比较两组的一次性穿刺成功率,随访患者36个月内瘘相关并发症的发生情况,进行Kaplan-Meier生存曲线分析。 结果 试验组的一次性穿刺成功率高于对照组（P<0.01）;试验组内瘘相关并发症发生率低于对照组（P<0.01）;试验组并发症发生时间为（21.42±11.37）个月,晚于对照组（14.71±9.18）个月,差异有统计学意义（P<0.01）。 结论 零压力改良穿刺法能提高疑难内瘘一次性穿刺成功率,减少疑难内瘘相关并发症,推迟动静脉内瘘相关并发症发生时间。

Application of zero-pressure modified puncture technique in hemodialysis patients with difficult arteriovenous fistula

Objective To explore the effects of zero-pressure modified puncture technique in hemodialysis patients with difficult arteriovenous fistula（AVF）. Methods The hemodialysis patients with difficult AVF at a hemodia-lysis center in a tertiary hospital from January 2014 to April 2016 were recruited and randomly allocated into an experimental group（n=64） and a control group（n=62）. The patients in the experimental group were punctured with the zero-pressure modified puncture technique,while the patients in the control group were punctured with routine method. The first-attempt success rate was compared between 2 groups. All patients were followed up for 36 months and relevant complications were recorded. Kaplan-Meier survival curve and log-rank test were conducted. Results The first-attempt success rate in the experimental group was significantly higher than that in the control group（P<0.01）;the incidence of the complications of AVF in the experimental group was significantly lower than that in the control group（P<0.01）;the duration without complication of AVF in the experimental group as（21.42±11.37） months was significantly longer than that in the control group as（14.71±9.18） months（P<0.01）. Conclusion For difficult AVF,zero-pressure modified puncture technique can increase first-attempt success rate,decrease complications of difficult AVF and significantly prolong the duration without complications.