应用扣眼穿刺法预防内瘘血管瘤样扩张的效果观察

目的探讨内瘘扣眼穿刺法的正确使用及其预防动静脉内瘘血管瘤样扩张的效果。方法方便性抽样选择2007年1月至2011年12月在浙江省人民医院血液净化中心采用自体动静脉内瘘穿刺进行维持性血液透析的患者120例，分别采用扣眼法（试验组60例）及传统区域法（对照组60例）穿刺内瘘，比较两组患者内瘘血管瘤样扩张发生情况。结果试验组患者均未发生穿刺局部血管呈圆瘤样扩张膨大，有5例患者内瘘穿刺点前方血管呈粗条状扩张。对照组患者出现穿刺部位血管呈圆瘤状扩张49例，粗条状扩张6例。两组比较，差异具有统计学意义（P〈0．01）。结论对维持性血液透析患者采用扣眼法穿刺内瘘可有效预防内瘘血管瘤样扩张，且穿刺成功率高，疼痛感轻，提高了患者的透析依从性，尤其适合于血管条件差无法进行绳梯法穿刺的患者。

Effects of Button-hole Puncturing on Prevention of Internal Fistula Angiomatous Ectasia

Objective To explore the proper use of button--hole puncturing and the effects of button-hole puncturing on prevention of internal fistula angiomatous ectasia. Methods By convenience sampling, totally 120 patients with maintenance hemodialysis by autogenous arteriovenous fistula puncture were divided into experimental group and control group, with 60 patients in each group. Incidence of internal fistula angiomatous expansion were compared between the two groups. Results No percutaneous vascular angiomatous expansion was found for patients in the experimental group, and 5 cases with vascular rough strips in front of puncture point ectasia. Totally 49 patients were detected with vascular tumor ectasia and 6 pa- tients with vascular rough strips in the control group. The differences were statistically significant （P〈0.01）. Conclusion On maintenance hemodialysis fistula by using buttonhole puncture in patients with vascular ectasia can be effective in preventing fistula, and high success ratio of puncture, release pain, improves patient compliance for dialysis, particularly suitable for poor vascular conditions which were unable to be punctured by rope ladder.