血液透析后15例穿刺点迟发性出血的原因分析及护理

目的:观察血液透析后穿刺点迟发性出血的原因,减少和预防迟发性出血。方法:对1998年5月-2010年6月的15例直接动静脉穿刺透析者在治疗后出现穿刺点迟发性出血进行回顾性分析。结果:15例患者均为慢性肾功能衰竭患者,1例透析后6小时测血压时出现穿刺点疼痛、肿胀,血压190mmHg/120mmHg;12例均于透析后第二天用力排便时穿刺点出现疼痛肿胀;2例为透析后第六天晨起用力排便时出现穿刺点疼痛肿胀。采取积极的止血等措施后,最长6天血肿消散吸收。结论:长期透析者,最好选择作动静脉内瘘术。对直接动静脉穿刺行透析者,要提高穿刺成功率,减少对血管的损伤;治疗结束加压包扎穿刺点,一旦发生出血立即采取积极的止血措施。

The Analysis and Nursing of 15 Patients after Hemodialysis with Delayed Bleeding at Puncture Site

Objective：To observe the reasons of patients after hemodialysis with delayed bleeding at puncture site ,to reduce and prevent the delayed bleeding. Methods： The author analysed retrospectively the 15 patients admitted from May 1998 to June 2010, who had delayed bleeding at puncture site after direct arteriovenous puncture hemodialysis. Results： 15 patients were suffering from chronic renal failure, 1 patient had pain and swelling 6 hours after hemodialysis puncture when his blood pressure went up to 190/120mmHg; 12 cases had pains, and swelling the next day after hemodialysis puncture when forced defecation： 2 cases had pains, and swelling at the sixth day morning after hemodialysis puncture v, hen forced defecation. Active measures like stopping the bleeding etc, were taken. , then, the hematoma can be dissipated and absorbed at the most of 6 days. Conclusion： For long-term dialysis, the best choice is arteriovenous fistula. As for direct arteriovenous puncture hemodialysis patients, we should improve the success rate and reduce blood vessel damage; bandage puncture with pressure at the end of treatment, once bleeding occurred, active measures must be taken to stop the bleeding immediately.