改良穿刺法在维持性血液透析患者中的应用及临床观察

目的寻找能减轻维持性血液透析患者穿刺疼痛并减少对动静脉内瘘管损伤的穿刺方法。方法方便性抽样选取某军医大学附属医院血透室100例使用前臂动静脉内瘘管作为血液透析血管通路的患者,采用自身对照法。第1次采用常规法(针尖斜面朝上,进针角度为15°～25°)穿刺,第2次使用改良法(针尖斜面向右旋转45°,进针角度为35°～45°)穿刺,观察两种穿刺方法患者的疼痛程度、压迫止血时间、穿刺点渗血发生情况及每分钟血流量。结果患者改良穿刺法痛觉评分为(2.30±0.27)分,常规穿刺法痛觉评分为(3.92±0.3)分,两种方法比较差异有统计学意义(P<0.05),且动静脉内瘘管使用时间越短的患者对于使用改良穿刺法减少穿刺疼痛的效果越明显(P<0.05);穿刺点渗血次数、压迫止血时间改良法明显少于常规法(P<0.01),每分钟血流量两组间差异无统计学意义(P>0.05)。结论改良穿刺法能明显减轻维持性血液透析患者的穿刺疼痛及对动静脉内瘘管的损伤,值得在临床推广应用。

Clinical Observation and Application of Improved Veinpuncture in Patients with Maintained Hemodialysis

Objective To explore the method of veinpuncture to relieve pain and release injury of arteriovenous fistula. Methods A total of 100 patients with forearm arteriovenous fistula as hemodialysis vascular access were enrolled in the study. Self-control method was used. Routine veinpuncture method（with needle beve up,needle angle 15 to 25 degree ） was used for the first time,and improved veinpuncture（with needle bevel rotating to the right for about 45 degree,needle angle 35 to 45 degree） was used for the second time. The extent of pain, time of hemostasis and bleeding of puncture point were observed. Results The pain score of patients with improved veinpuncture was 2.30 ±0.27 and the pain score of patients with routine veinpuncture was 3.92±0.3. The difference was statistically significant between the two treatments（P〈 0.05）. Compared with that of routine veinpuncture,the time of hemostasis and bleeding of puncture point was significantly decreased with improved veinpuncture（P〈0.01）. There was no significant difference on blood flow per minute between the two groups（P〈0.05）. Conclusion Improved veinpuncture in patients with maintained hemodialysis can effectively alleviate the extent of pain and release injury of arteriovenous fistula,which deserves futher clinical promotion.